AN  INDEX 


DISEASES  AND  THEIR  TREATMENT. 


L.   &   B.   PUBLISH    THE   FOLLOWING 

WORKS    BY    THE     SAME    AUTHOR. 


THE  PKACTICE  OF  MEDICINE. 

Fourth  American  Edition.     8vo.     Cloth,  $6.00.     Sheep,  $7  00. 


A  PEACTICAL  TKEATISE  ON  THE  DISEASES  OF  INFANCY  AND 

CHILDHOOD. 

Second  American  Edition.     8vo.     Price  $3.00. 


A  MEMOKANDA  OF  POISONS. 
32mo.,  cloth.     50  cents. 


THE  SIGNS  AND  DISEASES  OF  PREGNANCY. 
Preparing. 


AN 


INDEX  OF  DISEASES 


AND   THEIR 


TREATMENT. 


THOMAS  HAWKES  TANNER,  M.D.,  F.L.S., 

MEMBER   OF   THE   ROYAL   COLLEGE   OF    PHYSICIANS,   ETC. 


PHILADELPHIA: 

LI:N'DSAY    &    BLAKISTON'. 
186  7. 


SHERMAN     k     CO.,     PRINTERS. 


m 

100 
I?fe7 


PREFACE. 


The  present  volume  is  intended  to  facilitate  the  daily  work  of 
the  busy  practitioner;  and  especially  to  help  him  in  successfully 
managing  such  cases  of  disease  as  do  not  yield  to  treatment  so 
readily  as  might  be  desired.  The  student  who  wishes  to  learn  the 
nature  of  the  tools  with  which  he  will  have  to  work,  and  the  best 
mode  of  employing  them,  must  seek  for  this  information  in  other 
treatises.  But  it  is  hoped  that  the  actual  laborer,  who  has  em- 
ployed his  customary  weapons  and  finds  himself  baffled,  will  re- 
ceive useful  suggestions  from  the  following  pages. 

In  constructing  the  various  articles  of  which  this  Index  is  com- 
posed, the  Author  has  endeavored  by  giving  a  brief  description  of 
each  disease  to  make  its  diagnosis  sure.  With  regard  to  the  sec- 
tions on  Treatment,  it  is  to  be  remembered  that  the  numbers 
appended  to  the  drugs  not  only  refer  to  the  Formula?,  but  indicate 
those  remedies  on  which  it  is  believed  that  reliance  should  be 
chiefly  placed.  As  a  rule,  however,  most  of  the  agents  which 
have  been  recommended  by  difterent  authorities  are  mentioned ; 
although  where  they  are  not  deemed  particularly  useful  either  no 
reference  is  given  for  the  mode  in  which  they  are  to  be  prescribed, 
or  they  are  placed  in  a  separate  paragraph. 

It  is  only  necessary  to  add  that  the  Formulae  have  been  reprinted 
from  the  last  edition  of  the  Author's  Practice  of  Medicine,  with  a 


vi  PREFACE. 


few  alterations  and  additions.  Each  prescription  has  been  written 
in  accordance  with  the  rules  and  preparations  of  the  British  Phar- 
macopoeia— a  work  which  the  practitioner  will  esteem  the  more 
highly,  the  more  attentively  he  studies  its  pages. 


Henrietta  Street,  Cavendish  Square, 
1866. 


TABULAR  SYNOPSIS. 


ABSCESSES: 

I.  Abscess  of  Brain,  p.  67. 
II.  Abscess  of  External  Auditory  Canal,  p.  188. 

III.  Abscess  of  Tonsil,  p.  257. 

IV.  Retro-Pharyngeal  Abscess,  p.  229. 
V.  Empj'ema,  p.  i05;  210. 

VI.  Abscess  of  Abdominal  "Walls,  p.  33. 
VII.  Hepatic  Abscess,  p.  137. 
VIII.  Perinephritic  Abscess,  p.  33;  203. 
IX.  Abscess  around  Cajcum,  p.  55;  204. 

X.  Prostatic  Abscesa,  p.  218. 

XI.  Pelvic  Abscess,  p.  33  ;  201. 

XII.  Ovarian  Abscess,  p.  33;  192. 

XIII.  Abscess  of  Vaginal  Labia,  p.  273. 

XIV.  Lumbar,  Psoas,  and  Iliac  Abscess,  p.  166. 
XV.   Mammary  Abscess,  p.  167. 

XVI.  Abscess  of  Bone,  p.  187. 
XVII.   Boils,  p.  50.     Stves,  p.  245, 
XVIII.  Carbuncle,  p.  57". 
XIX.  Bubo,  p.  54. 
XX.  Strumous  Abscess,  p.  236. 


BLADDER    DISEASES: 

I.  Vesical  Irritability,  p.  275. 
II.  Vesical  Spasm,  p.  *276. 

III.  Vesical  Paralysis,  p.  276. 

IV.  Vesical  Inflammation,  1.  Acute  Cystitis,  p.  274. 

2.  Chronic  Cystitis,  p.  275. 
V.  Vesical  Tumors,  p.  276. 
VI.  Urinary  Calculi,  p.  263. 


VII.  Enuresis,  p.  110. 


BLOOD    DISEASES: 
I.  Ana3mia,  p.  88. 
II.  Chlorosis,  p.  70. 

III.  Graves'  Disease,  p.  128. 

IV.  Leucocythemia,  p.  165. 
V.  Hyperemia,  p.  147. 

VI.  Ichorhajmia,  or  Pysemia.  p.  149  ;  221. 
VII.   Piarhjemia,  p.  208"'. 
VIII.  Acholia,  p.  33. 
IX.  Glucohiemia,  p.  91. 

X.   Urajmia,  p.  263. 
XL  Ha^matozoa,  p.  128. 
XII.  Thrombosis,  p.  254.     Embolism,  p.  104, 

XIII.  Scurvy,  p.  237. 

XIV.  Purpura,  p.  221. 
XV.  Black  Leg,  p.  50. 

XVI.  Cellulitis  Venenata,  p.  64, 


Vlll 


TABULAR    SYNOPSIS. 


BLOOD    DISEASE  S— (continued) : 

XVII.  Glanders,  p.  124. 

XVIII.  Hydrophobia,  p.  146. 

XIX.  Elephantiasis  Graecorum,  p.  103. 

XX.  Pellagra,  p.  199. 


BLOODVESSEL    DISEASES: 
I.  Aortitis,  p.  41. 
11.  Aortic  Aneurism,  p.  39. 

III.  Phlebitis,  p.  205. 

IV.  Phlebolites,  p.  205. 

V.  Phlegmasia  Dolens,  p.  205. 
VI.  Nffivus,  p.  178. 


BONE   DISEASES: 
I.  Caries,  p.  62. 
II.  Necrosis,  p.  179. 

III.  Periostitis,  p.  203. 

IV.  Osteitis,  p.  187. 

V.  Osteomyelitis,  p.  187. 
VI.  Osteomalacia,  p.  187. 
VII.  Osteoid  Cancer,  p.  187. 
VIII.  Kickets,  p.  232. 
IX.  Coccyodynia,  p.  74. 
X.  Spina  Bifida,  p.  240. 


BRAIN   DISEASES: 

I.  Apoplexy,  p.  43.     Cerebral  Hemorrhage,  p.  44  ;  64. 
II.  Hydrocephalus,  p.  145.     Hydrocephaloid  Disease,  p.  145. 
III.  Coma,  p.  75. 
IV.  Compression  of  Brain,  p.  76. 
V.  Concussion  of  Brain,  p.  76. 
VI.  Coup  de  Soleil,  p.  84. 
VII.  Inflammation,  1.  Simple  Meningitis,  p.  65. 

2.  Cerebritis,  p.  65. 

3.  Acute  Encephalitis,  p.  65. 

4.  Chronic  Encephalitis,  p.  66. 

5.  Softening  ;   Induration  ;  Tumors,  p.  67. 

6.  Tubercular  Meningitis,  p.  68. 

7.  Hypertrophy  ;  Atrophy,  p.  69. 
VIII.  Alcoholism,        1.   Delirium  Tremens,  p.  91. 

2.  Dipsomania,  p.  95. 
IX.  Insanity,  1.  Progressive  Paralysis,  p.  153. 

2.  Insanity  with  Epilepsy,  p.  153. 

3.  Mania,  p.  153. 

4.  Puerperal  Mania,  p.  219. 

5.  Monomania,  p.  154. 

6.  Dementia,  p.  154. 

7.  Idiocy,  p.  154. 

8.  Cretinism,  p.  85. 
X.  Headache,  p.  131. 

XL  Vertigo,  ji.  274. 
XII.  Paralysis,  p.  193. 

XIII.  Epilepsy,  p.  110. 

XIV.  Aphasia,  p.  42. 
XV.  Convulsions,  p.  80. 

XVI.  Amaurosis,  p.  35. 


Eclampsia  Nutans,  p.  102. 


BREAST   DISEASES: 

I.  Inflammation,  1.  Acute  Mammitis,  p.  170. 

2.  Chronic  Mammitis,  p.  171. 


TABULAR    SYNOPSIS. 


IX 


BKEAST   DISEASE  S— (continued) : 


II.  Tumors, 


III. 

IV. 

V. 


1.  Lacteal,  p.  168. 

2.  Fatty,  p.  1G9. 

3.  Eiicliondroniatous  and  Fibroid, 

4.  Fibro-Plastic,  p.  169. 
6.  Hydatid,  p.  16'J. 

6.  Clironic  Mammary,  p.  169. 

7.  Mucous  Cysts,  p.  169. 

8.  Carcinoma,  p.  170. 
Mastodynia,  p.  171. 
Mammary  Abscess,  p.  167. 
Mammary  Hypertrophy,  p.  168. 

VI.  Mammillary,  or  Nipple  Diseases,  p.  170. 
VII.  Agalactia,  p.  35. 
VIII.  Galactorrhoea,  p.  119. 


p.  169. 


CALCULOUS   CONCRETIONS; 
I.  Rhinolithes,  p.  231. 
II.  Phlebolites,  p.  205. 

III.  Intestinal  Concretions,  p.  156. 

IV.  Gall  Stones,  p.  120. 

V.  Pancreatic  Calculi,  p.  193. 
VI.  Urinary  Calculi,  p,  263. 
VII.  Tophi  or  Chalk-Stones,  p.  127. 
VIII.  Lacteal  Calculus,  p.  168, 


CANCER  (p.  56): 

I.  Varieties,      .     1.  Scirrhus,  or  Hard  Cancer,  p.  235. 

2.  Medullary,  or  Soft  Cancer,  p.  172. 

3.  Epithelial  Cancer,  p.  112. 

II.  Sub-Varieties,  1.  Colloid,  or  Gum  Cancer,  p.  75. 

2.  Melanoid,  or  Black  Cancer,  p.  172. 

3.  Osteoid  Cancer,  p.  187. 

4.  Fungus  Haematodes,  p.  128. 

5.  Villous  Cancer,  p.  277. 

III.  Of  Special  Organs,  1.  Cancer  of  Tongue,  p.  256. 

2.  Cancer  of  Tonsil,  p.  258. 

3.  Cancer  of  (Esophagus,  p.  184. 

4.  Cancer  of  Stomach,  p.  121. 

5.  Cancer  of  Duodenum,  p.  97. 

6.  Cancer  of  Rectum,  p.  222. 

7.  Cancer  of  Liver,  p.  134. 

8.  Cancer  of  Kidney,  p.  226. 

9.  Cancer  of  Pancreas,  p.  193. 

10.  Cancer  of  Breast,  p.  170. 

11.  Cancer  of  Vulva,  p.  278. 

12.  Cancer  of  Uterus,  p.  265. 

13.  Cancer  of  Penis,  p.  201. 

14.  Cancer  of  Testicle,  p.  251. 

15.  Chimney-Sweeper's  Cancer,  p.  69. 

16.  Cancer  of  Bladder,  p.  277. 

17.  Pulmonary  Cancer,  p.  219. 

18.  Cardiac  Cancer,  p.  58. 

19.  Mediastinal  Cancer,  p.  157. 


DEFORMITIES: 

I.  Spinal  Curvature,  p.  240. 

II.  Rickets,  p.  232. 

III.  Spina  Bifida,  p.  240. 

IV.  Osteomalacia,  p.  187. 
V.  Coccyodynia,  p.  74. 

VI.  Wry-Neck,  p.  282. 

VII.  Club  Foot,  p.  73. 


TABULAR    SYNOPSIS. 


DEFOE  MITIE  ^—{continued) : 

VIII.  Flat  Foot,  p.  117. 
IX.  Knock-Knees,  p.  162. 

X.  Epispadias,  p.  148. 
XI.  Hypospadias,  p.  148. 
XII.  Cretinism,  p.  85. 


DEGENERATIONS   OF   TISSUE 

I.  Fatty  Degeneration,  p.  116. 

II.  Amyloid  Degeneration,  p.  37. 

III.  Mineral  Degeneration,  p.  174. 

IV.  Osteomalacia,  p.  187. 
V.  Cardiac  Atrophy,  p.  58. 

VI.  Hepatic  Degenerations,  p.  135. 
VII.  Renal  Degenerations,  p.  226. 
VIII.  Arcus  Senilis,  p.  83. 
IX.  Cerebral  Softening,  p.  67. 


DROPSY   (p.  96) : 

I.  Ascites,  p.  45. 
II.  (Edema,  p.  184. 

III.  Anasarca,  p.  38. 

IV.  Sclerema,  p.  235. 

V.  Bright's  Disease,  p.  51 ;  226. 
VI.  Acute  Desquamative  Nephritis,  p.  180. 
VII.  Hydrocephalus,  p.  145. 
VIII.  Hydrothorax,  p.  147 ;  210.  ' 

IX.  Pneumothorax,  with  EflVision,  p.  213. 

X.  Cardiac  Dropsy,  p.  60. 
XI.  Hydro-Pericardium,  p.  146 ;  202. 
XII.  Beriberi,  p.  49. 

XIII.  Hydrocele,  p.  144. 

XIV.  Scrotal  (Edema,  p.  236. 
XV.   Hydronephrosis,  p.  146. 

XVI.  Hydrorachis,  p.  147 ;  240. 
XVII.  (Edema  of  Glottis,  p.  164. 
XVIII.  Ovarian  Dropsy,  p.  191. 

XIX.  Dropsy  of  Fallopian  Tube,  p.  116. 

EAR   DISEASES: 

I.  Otitis,  1.  Inflammation  of  External  Meatus,  p.  188. 

2.  Inflammation  of  Membrana  Tympani,  p.  180. 

3.  Inflammation  of  Tympanic  Cavity,  p.  189. 

II.  Diseases  of  Eustachian  Tube,  1.  Obstruction  of  Tube,  p.  115.    • 

2.  An  Open  Condition  of  Tube,  p.  115. 

III.  Otalgia,  or  Earache,  p.  188. 

IV.  Otorrhcea,  p.  190. 
V.  Otorrhagia,  p.  190. 

VI.  Deafness,  1.  Rheumatism  of  Ear,  p.  87. 

2.  (iout  of  Ear,  p.  87. 

3.  Nervous  Deafness,  p.  87. 
VII.  Hajmatoma  Auris,  p.  113. 

ENTOZOA  (p.  107): 

I.  Trematoda,  or  Flukes,  1.  Fasciola  Hepatica,  p.  107;  129. 

2.  Distoma  Lanceolatiim,  p.  107. 

8.  Distoma  Ophthalmobium,  p.  107. 

4.  Distoma  Crassum,  p.  107. 

5.  Distoma  Heterophyes,  p.  108. 

6.  Distoma  Hitmatobium,  p.  108;  128. 

7.  Tetrastoma  Renale,  p.  108. 

8.  Hexathyridium  Pinguicola,  p.  108. 

9.  Hexathyridium  Venarum,  p.  108  ;  128. 


TABULAR    SYNOPSIS.  XI 

E  N  T  0  Z  O  A.— {continued) : 

II.  Cestoda,  or  Tapeworms,  1.  Tajnia  Solium,  p.  108;  158. 

2.  Tienia  McdiocaiKsUata,  p.  108;   158. 

3.  Tienia  Marginala,  p.  108. 

4.  Taenia  Echinococus,  p.  108;   136. 

5.  Bothriocephalus  Latus,  p.  108;  158. 

III.  Nematoda,  or  Round  Worms,  1.  AscarLs  Lumbricoidos,  p.  109;  158. 

2.  Ascaris  Mvstax,  p.  109. 

3.  Tricocephalus  Dispiir,  p.  109;  158. 

4.  Trichina  Spiralis,  p.  109;  270. 

5.  Strongylus  Bronchialis,  p.  109. 

6.  Eustrongylus  Gigas,  p.  109. 

7.  Sclerostuma  Duodenale,  p.  109;   158. 

8.  Oxyuris  Vcrmicularis,  p.  109  ;  158. 

9.  Dracunculus  Medincnsis,  p.  95;  109. 

IV.  Acanthotheca  (not  true  Helminths),  1.  Pentastoma  Tienioides,  p.  109. 

2.  Pentastoma  Constrictum,  p.  109. 
V.  Pseudelminths,  1.  Dactylius  Aculeatus,  p.  109. 
2.  Spiroptera  Hominis,  p.  109. 
8.  Diplosoma  Crenatum,  p.  109. 
4.  Gordius  Aquaticus,  p.  109. 

EPIPHYTES  (p.  112): 

I.  In  Cutaneous  Diseases,  1.  Microsporon  Furfur,  p.  112;  255. 

2.  Microsporon  Mentagrophytes,  p.  112;  255. 

3.  Microsporon  Audouini,  p.  112;  255. 

4.  Tricophyton  Tonsurans,  p.  112;  255. 

5.  Tricophyton  Sporuloides,  p.  112  ;  211. 

6.  Achorion  Schonleinii,  p.  112;  255. 
II.  In  Stomach  Diseases,  1.  Sarcina  Ventriculi,  p.  112;  124. 

2.   Cryptococcus  Cerevisiie,  p.  112;  124. 

III.  In  Aphtha,  1.  Oidium  Albicans,  p.  43;   112. 

2.  Leptothrix  Buccalis,  p.  43;  112. 

IV.  In  Fungus  Foot  of  India.     Chionyphe  Carteri,  p.  112;  176. 

EPIZOA  (p.  113): 

I.  On  the  Skin,  1.  Pediculus,  or  Louse,  p.  113;  206. 

2.  Pulex  Irritans,  or  Flea,  p.  113. 

3.  Chigoe,  or  Jigger,  p.  113. 

4.  Ticks,  or  Ixodes,  p.  113. 

5.  Argades,  p   113. 

6.  Acanthia  Lectularia,  or  Bug,  p.  113. 

7.  Leptus  Autumnalis,  or  Harvest  Bug,  p.  113. 
II.  In  the  Skin,  1.  Acarus  Scabiei,  or  Itch  Insect,  p.  113  ;  233. 

2.  Acarus  FoUiculorum,  or  Pimple  Mite,  p.  113.  ' 

EYE    DISEASES: 

I.  Diseases  of  Eyelids,  1.  Ectropion,  p.  103. 

2.  Entropion,  p.  110. 

3.  Epiphora,  p.  112. 

4.  Ophthalmia  Tarsi,  p.  186. 

5.  Ptosis,  p.  219. 

6.  Trichiasis,  p.  259. 
II.  Varieties  of  Sight,  1.  Emmetropia,  p.  104, 

2.  Myopia,  p.  177. 

3.  Presbyopia,  p.  217. 

4.  Asthenopia,  p.  46. 

5.  Astigmatism,  p.  48. 

6.  Color-Blindness,  p.  75. 

7.  Hj'permetropia,  p.  147. 

8.  Amblyopia,  p.  36. 

9.  Diplopia,  p.  36;  95. 

10.  Hemiopia,  p.  36 ;   133. 

11.  Hemeralopia,  p.  36;  132. 


xii  TABULAR    SYNOPSIS. 

EYE    DISEASE  S— (continued) : 

12.  Nyctalopia,  p.  36;   183. 

13.  Photophobia,  p.  206. 
III.  Conjunctivitis,  1.  Catarrhal  Ophthalmia,  p.  77. 

2.  Purulent  Ophthalmia,  p.  78. 

3.  Strumous  Ophthalmia,  p.  79. 

4.  Granular  Conjunctiva,  p.  79. 

IV.  Sclerotitis,  1.  Kheumatic  Ophthalmia,  p.  235. 

2.  Catarrho-Kheumatic  Ophthalmia,  p.  236. 
V.  Corneitis,  1.  Keratitis,  p.  81. 

2.  Syphilitic  Keratitis,  p.  82. 

3.  Opacity  of  Cornea,  p.  82. 

4.  Ulcers  of  Cornea,  p.  82. 

5.  Conical  Cornea,  p.  82. 

6.  Arcus  Senilis,  p.  83. 
VI.  Diseases  of  Iris,  1.  Iritis,  p.  159. 

2.  Inflammation  of  Iris  and  Cornea,  p.  161. 

3.  Mydriasis,  p.  161. 

4.  Myosis,  p.  161. 
VII.  Choroiditis,  p.  73. 

VIII.  Retinitis,  p.  228. 
IX.   Cataract,  p.  63. 

X.  Muscse  Volitantes,  p.  175. 
XI.  Glaucoma,  p.  124. 
XII.  Amaurosis,  p.  35. 
XIII.  Exophthalmos,  or  Proptosis  Oculi,  p.  115;  128;  217. 

FEMALE   ORGANS   OF   GENERATION    (Diseases  of): 
I.  Vulval  Pruritus,  p.  279. 
II.  Vulval  Tumors,  1.  Encysted  Tumors,  p.  279. 

2.  Fibrous  and  Fatty  Tumors,  p.  280. 

3.  Warty  Growths,  p.  280. 

4.  Hypertrophy  of  Labia,  p.  280. 

5.  Abscess  of  Labia,  p.  280. 

6.  Pudendal  Hsematocele,  p.  280. 

III.  Inflammation  of  Vulva,  1.  Simple  Vulvitis,  p.  280. 

2.  Gangrenous  Vulvitis,  p.  280. 

3.  Follicular  Inflammation,  p.  281. 

4.  Erythema,  p.  281. 

5.  Infantile  Leucorrhoea,  p.  281. 

IV.  Vulval  Corroding  Ulcer,  p.  278. 

V.  Vulval  Cancer,  p.  278. 
VI.   Clitoritis,  p.  73. 

VII.  Vascular  Tumor  of  Urethra,  p.  273. 
VIII.  Vaginal  Diseases,  1.  Vaginal  Occlusion,  p.  271. 

2.  Vaginismus,  p.  272. 

3.  Vaginitis,  p.  272. 

4.  Vaginal  Prolapsus,  p.  271. 

5.  Vaginal  Tumors,  p.  272. 
IX.  Pelvic  Cellulitis,  p.  200. 

X.  Pelvic  Haematocele,  p.  201. 

XI.  Uterine  Diseases,  1.  Amenorrhooa.  p.  36. 

2.  Lcucorrhwa,  p.  165;  273. 

3.  Dysmenorrlicea,  p.  99. 

4.  Menorrhagia,  p.  173. 

5.  Uterine  Hemorrhage,  p.  268. 

6.  Endometritis,  p.  106. 

7.  Metritis,  p.  174. 

8.  Ulceration,  p.  270. 

9.  Cancer,  p.  2»)5. 

XII.  Uterine  Tumors,  1.  Fibroid  Growths,  p.  268. 

2.  Polypi,  p.  269. 

3.  Cystic  Growths,  p.  269. 

XIII.  Uterine  Displacements,  1.  Prolapsus  and  Procidentia,  p.  266. 

2.  Retroflexion  and  Anteflexion,  p.  267. 

3.  Retroversion  and  Antcversion,  p.  267. 

4.  Inversion,  p.  268. 


TABULAR    SYNOPSIS. 


Xlll 


FEMALE    ORGANS    OF    G  E  N  E  R  A  T  I  O  N— (conilmMerf) : 


XIV.  Diseases  of  Ovaries  and  Oviducts. 


XV.  Impotence  and  Sterility,  p.  150. 
XVI.  Gonorrhcea,  p.  126.     Urethritis,  p.  263. 
XVII.  Syphilis,  p.  247. 


1.  Ovaritis,  p.  192. 

2.  Ovarian  Tumors,  p.  191. 

3.  Displacements  of  Ovary,  p.  191. 

4.  Dropsy  of  Fallopian  Tube,  p.  116. 


FEVERS    (p.  113;  116): 

I.  Continued  Fevers,  1.  Simple  Continued  Fever,  p.  237. 

2.  Typhus,  p.  262. 

3.  Typhoid  Fever,  p.  261. 

4.  Relapsing  Fever,  p.  22.5. 

II.  Intermittent  Fevers,  1.  Intermittent  Fever,  or  Ague,  p.  155. 
2.  Brass-Founder's  Ague,  p.  51. 

III.  Remittent  Fevers,  1.  Remittent  Fever,  p.  225. 

2.  Yellow  Fever,  p.  282. 

IV.  Eruptive  Fevers,  1.  Rubeola,  p.  232. 

2.  Small-Pox,  p.  238. 

3.  Cow-Pox,  p.  84. 

4.  Chicken-Pox,  p.  69. 

5.  Measles,  p.  171. 

6.  Scarlet  Fever,  p.  233. 

7.  Dengue,  p.  92. 

8.  Erysipelas,  p.  42. 

9.  Miliaria,  p.  174. 
10.  Plague,  p.  209. 


FORMULA    (p.  285): 
I.  Aliments,  p.  289. 
II.  Alteratives  and  Resolvents,  p.  293. 

III.  Antacids,  p.  301. 

IV.  Antiseptics,  p.  301. 

V.  Antispasmodics,  p.  304. 
VI.  Astringents,  p.  305. 
VII.  Baths,  p.  309. 
VIII.  Cathartics  and  Anthelmintics,  p.  312. 
IX.  Caustics  and  Counter-irritants,  p.  319. 

X.  Diaphoretics  and  Diuretics,  p.  321. 
XI.  Emetics  and  Expectorants,  p.  324, 
XII.  Gargles  and  Inhalations,  p.  326. 

XIII.  Lotions,  Liniments,  Collyria,  and  Ointments,  p.  329. 

XIV.  Narcotics  and  Sedatives,  p.  335. 
XV.  Refrigerants  and  Salines,  p.  342. 

XVI.  Stimulants,  p.  343. 
XVII.  Tonics,  p.  345. 
XVIII.  Uterine  Therapeutics,  p.  354. 
XIX.  Climates  for  Invalids,  p.  358. 
XX.  Mineral  Waters,  p.  380. 


FURUNCULAR   INFLAMMATIONS; 

I.  Boils,  p.  50. 
II.  Carbuncles,  p.  57. 

III.  Malignant  Vesicle,  p.  167. 

IV.  Styes,  p.  245. 


GOUT  AND   RHEUMATISM; 

I.  Gout,  p.  126. 
II.  Acute  Rheumatism,  p.  229. 
Ill^'hronic  Rheumatism,  p.  230. 
IV.  Rheumatoid  Arthritis,  p.  231. 


XIV  TABULAR   SYNOPSIS. 

GOUT   AND    'RE.'EJJ  M  AT  IS^H— {continued): 

V.  Lumbago,  p.  166  ;  230. 
VI.  Pleurodynia,  p.  211 ;  230. 
YII.  Sciatica,  p.  182;  230;  235. 
VIII.  Rheumatic  Ophthalmia,  p.  235. 

IX.  Gouty  and  Eheumatic  Deafness,  p.  87. 


HEMORRHAGE  (p.  130) : 

I.  Hemorrhagic  Diathesis,  p.  130. 
II.  Epistaxis,  p.  112. 

III.  Cerebral  Apoplex}',  p.  44. 

IV.  Cerebral  Hemorrhage,  p.  44 ;  64. 
V.  Cephalohfematoma,  p.  64. 

VI.  Otorrhagia,  p.  190. 
VII.  Hsematoma  Auris,  p.  128. 
VIII.  Spinal  Hemorrhage,  p.  242. 
IX.  Stomatorrhagia,  p.  245. 

X.  Hemoptysis,  p.  129. 
XI.  Pulmonary  Apoplexy,  p.  219. 
XH.  Hffimatemesis,  p.  128,  129. 

XIII.  Mehena,  p.  173. 

XIV.  Apoplexy  of  Liver,  p.  135. 
XV.  Haematuria,  p.  129. 

XVI.  Menorrhagia,  p.  173. 
XVII.  Uterine  Hemorrhage,  p.  268. 
XVIII.  Pudendal  Ha-matocele,  p.  280. 
XIX.  Pelvic  Hematocele,  p.  201. 
XX.  Scrotal  Hematocele,  p.  144. 


HEART  DISEASES: 

I.  Pericarditis,  p.  202.     Hydropericardium,  p.  146,  202. 
II.  Endocarditis,  p.  105. 
III.  Myocarditis,  p.  177. 
IV.  Valvular  Diseases,  p.  60. 

V.  Cardiac  Hypertrophy,  p.  59. 
VI.  Cardiac  Dilatation,  p.  59. 
VII.  Cardiac  Atrophy,  1.  Simple  Atrophy,  p.  58. 

2.  Fatty  Degeneration,  p.  58. 
8.  Fatty  Growth,  58. 
VIII.  Cyanosis,  p.  86. 

IX.  Cardiac  Rupture,  p.  60. 
X.  Angina  Pectoris,  p.  39. 
XI.  Cardiac  Aneurism,  p.  58. 
XII.  Cardiac  Cancer,  p.  58. 

XIII.  Cardiac  Functional  Derangement,  p.  59. 

XIV.  Intra-Thoracic  Tumors,  p.  158. 


HERNIA  (p.  140) : 

I. 

General  Varieties, 

p.  141,  1 

.  Reducible. 

2 

1.  Irreducible. 

3 

1.  Incarcerated. 

4 

;.  Strangulated. 

II. 

Special  Hernise,  p. 

141,    1. 

Oblique  Inguinal 

2. 

Direct  Inguinal. 

3. 

Congenital. 

4. 

Femoral. 

5. 

Umbilical. 

6. 

Ventral. 

7. 

Obturator. 

8. 

Ischiatic. 

9. 

Perineal. 

10. 

Vaginal. 

11. 

Labial. 

12. 

Diaphragmatic. 

TABULAR   SYNOPSIS. 


XV 


INFLAMMATION  (p.  151) ; 


I.  Nervous  System,  1. 

3. 
4. 


IV.  Organs  of  Digestion,  1. 
2. 
3. 
4. 


Cerebral  Meningitis,  p.  65. 
Cerobritis,  p.  65. 
Encephalitis,  p.  65. 
S{)inal  Meningitis,  p.  242. 

5.  Cerebro-Spinal  Meningitis,  p.  243. 

6.  Myelitis,  p.  176. 

7.  Neuritis,  p.  182. 

II.  Organs  of  Kespiration,  1.  Laryngitis,  p.  163. 

2.  Tracheitis,  or  Croup,  p.  85. 

3.  Bronchitis,  p.  51. 

4.  Pleurisy,  p.  210. 

5.  Pneumonia,  p.  211. 

6.  Pleuro-Pneumonia,  p.  211. 
III.  Organs  of  Circulation,  1.  Pericarditis,  p.  202. 

2.  Endocarditis,  p.  10-5. 

3.  Myocarditis,  p.  177. 

4.  Aortitis,  p.  41. 

5.  Phlebitis,  p.  205. 
Glossitis,  p.  2-55. 
Stomatitis,  p.  244. 
Parotitis,  p.  199. 
Tonsillitis,  p.  257. 

5.  Pharyngitis,  p.  204. 

6.  OEsophagitis,  p.  185. 

7.  Gastritis,  p.  122. 

8.  Duodenitis,  p.  97. 

9.  Enteritis,  p.  107. 

10.  Typhilitis,  or  Cfficitis,  p.  55. 

11.  Perityphlitis,  p.  204. 

12.  Colitis  (Dysentery),  p.  98. 

13.  Kectitis,  p.  225. 

14.  Hepatitis,  p.  187. 

15.  Pancreatitis,  p.  193. 

16.  Splenitis,  p.  244. 
V.  Urinary  Organs,  1.  Nephritis,  p.  179. 

2.  Acute  Desquamative  Nephritis,  p.  180. 

3.  Chronic  Desquamative  Nephritis,  p.  181. 

4.  Acute  Cystitis,  p.  274. 

5.  Chronic  Cystitis,  p.  275. 

6.  Urethritis,  p.  263. 

VI.  Male  Organs  of  Generation,  1.  Balanitis,  p.  48. 

2.  Prostatitis,  p.  218. 

3.  Testitis,  p.  251. 
VII.  Female  Organs  of  Generation,  1.  Vulvitis,  p.  280. 

2.  Clitoritis,  p.  73. 

3.  Vaginitis,  p.  272. 

4.  Pelvic  Cellulitis,  p.  200, 
6.  Metritis,  p.  174. 

6.  Endometritis,  p.  106. 

7.  Ovaritis,  p.  192. 
VIII.  Eye,   1.  Conjunctivitis,  p.  77. 

2.  Sclerotitis,  p.  235. 

3.  Corneitis,  p.  81. 

4.  Choroiditis,  p.  73. 

5.  Iritis,  p.  159. 

6.  Eetinitis,  p.  228. 
IX.  Bone,  1.  Periostitis,  p.  203. 

2.  Osteitis,  p.  187. 

3.  Osteomyelitis,  p.  187. 
X.  Various  Organs  and  Tissues,  1. 

2. 
3. 
4. 
5. 
6. 
7. 


Mammitis,  p.  170. 
Otitis,  p.  188. 
Peritonitis,  p.  203. 
Myositis,  p.  177. 
Angeioleucitis,  p.  38. 
Adenitis,  p.  34. 
Housemaid's  Knee,  p.  144. 
Cellulitis  Venenata,  p.  64. 


Xvi  TABULAR   SYNOPSIS. 

INTESTINAL   DISEASES: 

I.  Duodenal  Disease,  1.  Duodenitis,  p.  97. 

2.  Duodehal  Dyspepsia,  p.  97. 

3.  Perforating  Ulcer  ,  p.  97. 

4.  Cancer,  p.  97. 
II.  Enteritis,  p.  107. 

III.  Ca>citis,  p.  55.     Perityphlitis,  p.  204. 

IV.  Dysentery,  p.  98. 

V.  Diarrhoea,  p.  94.     Melaena,  p.  173. 
VI.   Cholera,  p.  70. 
VII.  Flatulence,  p.  117;  261. 
VIII.  Colic,  1.  Simple  Colic,  p.  74. 

2.  Copper  Colic,  p.  75. 

3.  Lead  Colic,  p.  164. 
IX.  Constipation,  p.  79. 

X.  Intestinal  Obstruction,  p.  156. 
XI.  Intussusception,  p.  159. 
XII.  Intestinal  Worms,  p.  158. 

XIII.  Intestinal  Perforation,  p.  157. 

XIV.  Intestinal  Concretions,  p.  156. 

XV.  Diseases  of  Kectum,  1.  Kectitis,  p.  225. 

2.  Foreign  Bodies  in  Eectum,  p.  119. 

3.  Rectal  Ulcers,  p.  225. 

4.  Rectal  Stricture,  p.  225. 

5.  Rectal  Prolapsus,  p.  224. 

6.  Rectal  Polypus,  p.  224. 

7.  Pruritus  Ani,  p.  218. 

8.  Rectal  Neuralgia,  p.  223. 

9.  Fistula  in  Ano,  p.  117. 

10.  Haemorrhoids,  p.  130. 

11.  Cancer,  p.  222. 
XVI.  Hernia,  p.  140. 


KIDNEY   DISEASES: 

I.  Inflammation,  1.  Nephritis,  p.  179. 

2.  Acute  Desquamative  Nephritis,  p.  180. 

3.  Chronic  Desquamative  Nephritis,  p.  181. 
II.  Eenal  Degeneration,  1.  Fatty  Degeneration,  p.  226. 

2.  Amyloid  Degeneration,  p.  227. 

3.  Cystic  Degeneration,  p.  227! 

III.  Hydronephrosis,  p.  146. 

IV.  Renal  Cancer,  p.  226. 
V.  Renal  Tubercle,  p.  228. 

VI.  Renal  Parasites,  p.  228. 
VII.  Diabetes  Mellitus,  p.  92. 
VIII.  Diuresis,  p.  95.     Polyuria,  p.  217. 
IX.  Chylous  Urine,  p.  73. 
X.  Hsematuria,  p.  129. 
XI.  Urinary  Deposits,  p.  263. 
XII.  Urinary  Calculi,  p.  263. 

XIII.  Enuresis,  p.  110. 

XIV.  Urajmia,  p.  263. 

XV.  Supra-Renal  Capsular  Diseases,  p.  246. 


LARYNGEAL    AND    TRACHEAL    DISEASES: 

I.  Aphonia,  p.  42. 
II.  Laryngitis,  1.  Acute  Laryngitis,  p.  163. 

2.  (Edema  of  Glottis,  p.  164. 

3.  Chronic  Laryngitis,  p.  164. 

III.  Laryngismus  Stridulus,  p.  163. 

IV.  Dysphonia  Clericorum,  p.  101. 
V.  Diphtheria,  p.  93. 

VI.  Croup,  p.  85. 
VII.  Foreign  Bodies  in  Air-Passages,  p.  118. 
VIII.  Haemoptysis,  p.  129. 


TABULAR    SYNOPSIS.  XVll 


LIVEE    DISEASES: 

.1.  Hepatic  Congestion,  1.  Passive  Congestion,  p.  134. 

2.  Active  Congestion,  p.  134. 

3.  Apoplexy  of  Liver,  p.  135. 
II.  Hepatic  Hypertrophy,  p.  136. 

III.  Inflammation,  1.  Hepatitis,  p.  137. 

2.  Cirrhosis,  p.  138. 

3.  Syphilitic  Hepatitis,  p.  138. 

4.  Inflammation  of  Bloodvessels,  p.  139. 

5.  Of  Biliary  Ducts  and  Gall-Bladder,  p.  139. 
IV.  Hepatic  Atrophy,  1.  Acute  or  Yellow  Atrophy,  p.  133. 

2.  Chronic  Atrophy,  p.  133. 
V.  Hepatic  Degeneration,  1.  Fatty  Degeneration,  p.  135. 

2.  Amyloid  Degeneration,  p.  135. 
8.  Pigment  Liver,  p.  136. 
VI.  Hepatic  Tumors,  1.  Cystic,  p.  136. 

2.  Cavernous,  p.  136. 

3.  Tubercular,  p.  136. 

4.  Hydatid,  p.  136. 
VII.  Hepatic  Cancer,  p.  134. 

VIII.  Gail-Stones,  p.  120. 
IX.  Jaundice,  p.  161. 
X.  Acholia,  p.  33. 


LUNG    DISEASES: 

I.  Catarrh,  p.  63.     Cough,  p.  83. 
II.  Influenza,  p.  152. 

III.  Bronchitis,  1.  Acute  Bronchitis,  p.  51. 

2.  Chronic  Bronchitis,  p.  52. 

3.  Catarrhus  Senilis,  p.  52. 

4.  Plastic  Bronchitis,  p.  52. 

5.  Mechanical  Bronchitis,  p.  53. 

6.  Secondary  Bronchitis,  p.  53. 

7.  Hay-Asthma,  p.  53. 

IV.  Hooping-Cough,  p.  143. 
V.  Asthma,  p.  46. 

VI.  Emphysema,  1.  Vesicular,  p.  105. 

2.  Interlobular,  p.  105. 
VII.  Pulmonary  Condensation,  1.  From  Various  Causes,  p.  220. 

2.  Pulmonary  Apoplexy,  p.  220. 

3.  Cirrhosis  of  Lung,  p.  73  ;  220. 

4.  Acquired  Pulmonary  Collapse,  p.  220. 

5.  Atelectasis,  p.  48;  221. 
VIII.  Pleurisy,  p.  210.     Pleuro-Pneumonia,  p.  211. 

IX.  Hydrothorax,  p.  147 ;  210. 

X.  Pneumothorax,  p.  213. 

XI.  Empyema,  p.  105  ;  210. 

XII.  Pneumonia,  p.  211. 

XIII.  Pulmonary  Gangrene,  p.  221. 

XIV.  Phthisis,  p.  206: 

XV.  Pulmonary  Cancer,  p.  219. 
XVI.  Intra-Thoracic  Tumors,  p.  158. 
XVII.  Foreign  Bodies  in  Air-passages,  p.  118. 
XVIII.  Dyspnoea,  p.  102;  Orthopncea,  p.  187. 
XIX.  Haemoptysis,  p.  129. 


LYMPHATIC    DISEASES: 

I.  Angeioleucitis,  p.  38. 

II.  Adenitis,  p.  34 ;  54. 

III.  Cellulitis  Venenata,  p.  64. 

IV.  Tabes  Mesenterica,  p.  250. 


XVlll 


TABULAR    SYNOPSIS. 


6. 

7. 

8. 

II.  Diseases  of  Testicle, 


MALE   ORGANS   OF   GENEEATION    (Diseases  of )  : 

I.  Diseases  of  Penis,  1.  Balanitis,  p.  48. 

2.  Hypospadias  and  Epispadias,  p.  148. 

3.  Phimosis,  p.  204. 

4.  Paraphimosis,  p.  199. 

5.  Priapism,  p.  217. 
Prostatitis,  p.  218. 
Prostatic  Enlargement,  p.  217. 
Cancer,  p.  201. 

1.  Acute  Testitis,  p.  251. 

2.  Chronic  Testitis,  p.  252. 

3.  Abscess  and  Fungus,  p.  252. 

4.  Scrofula,  p.  253. 

5.  Neuralgia,  p.  251. 

6.  Tumors,  p.  251. 

7.  Varicocele,  p.  273. 

8.  Hydrocele  and  Hematocele,  p.  144. 

III.  Diseases  of  Scrotum,  1.  Acute  ffidema,  p.  236. 

2.  Elephantiasis,  p.  236. 

3.  Chimney-Sweeper's  Cancer,  p.  69. 

IV.  Impotence  and  Sterility,  p.  150. 

V.  Gonorrhoea,  p.  125.     Urethritis,  p.  263. 
VI.  Spermatorrhoea,  p.  239. 
VII.  Syphilis,  p.  247.     Bubo,  p.  54. 
VIII.  Syphilization,  p.  249. 
IX.  Syphiliphobia,  p.  247. 


MELANOSIS: 

I.  True  Melanosis,  p.  172. 
II.  Spurious  Melanosis,  p.  173. 


MISCELLANEA: 

I.  Expectation  of  Life,  p.  115. 
II.  Death  Causes,  p.  87. 

III.  Weight  of  Body,  p.  287. 

IV.  Temperature  of  Body,  p.  250. 
V.  Spirometry,  p.  243. 

VI.  Suspended  Animation,  p.  246. 
VII.  Bites  of  Venomous  Keptiles,  p.  50. 
VIII.  Bites  of  Rabid  Animals,  p.  49. 
IX.  Obesity,  p.  183. 
X.  Dyspnoea,  p.  102.     Orthopncea,  p.  187. 
XL  Sleeplessness,  p.  237. 
XII.  Cough,  p.  83. 

XIII.  Hiccough,  p.  142. 

XIV.  Dysphagia,  p.  101. 

XV.  Vomiting  and  Retching,  p.  277. 
XVI.  Blows  and  Bruises,  p.  50. 
XVII.   Burns  and  Scalds,  p.  54. 
XVIII.  Anorexia,  p.  39. 

XIX.  Headache,  p.  131.     Vertigo,  p.  274. 


MOUTH   DISEASES: 

I.  Inflammation,  &c.,  1.  Follicular  Stomatitis,  p.  244. 

2.  Ulcerative  Stomatitis,  p.  244. 

3.  Cancrum  Oris,  p.  245. 

4.  Stomatorrhagia,  p.  245. 
II.  Toothache,  p.  258. 

III.  Aphthaj  of  Mouth,  p.  43. 

IV.  Parotitis,  p.  199. 
V.  Tonsillitis,  p.  2-57. 

VI.  Elongation  of  Uvula,  p.  204, 


TABULAR    SYNOPSIS.  XIX 


MUSCULAK   DISEASES: 

I.  Myalgia,  p.  175. 
II.  Pleurodynia,  p.  211. 

III.  Myositis,  p.  177. 

IV.  Phantom,  or  Muscular  Tumors,  p.  175. 
V.  Contusions  of  Abdominal  Parietcs,  p.  80. 

VI.  Abscess  of  Abdominal  Parictes,  p.  33. 
VII.  Lumbar,  Psoas,  and  Iliac  Abscess,  p.  166. 


NERVOUS   DISEASES: 

I.  Hysteria,  p.  148.     Bed  Case,  p.  49. 
II.  Catalepsy,  p.  62.     Ecstasy,  p.  102. 

III.  Chorea,  p.  72. 

IV.  Tetanus,  p.  253.     Trismus  Nascentium,  p.  2G0. 
V.  Epilepsy,  p.  110.     Convulsions,  p.  80. 

VI.  Sleeplessness,  p.  237. 
VII.  Hypochondriasis,  p.  147.     Syphiliphobia,  p.  247. 
VIII.  Inflammation,  &c.,  1.  Neuritis,  p.  182. 
2.  Neuroma,  p.  183. 
IX.  Neuralgia,  1.  Tic  Douloureux,  p.  181. 

2.  Hemierania,  p.  132;   182. 

3.  Sciatica,  p.  182 ;  235. 
X.  Hooping-Cough,  p.  143. 

XI.  Asthma,  p.  46. 
XII.  Laryngismus  Stridulus,  p.  163. 

XIII.  Nostalgia,  p.  183. 

XIV.  Headache,  p.  131. 


NEURALGIA  (p.  181): 

I.  Neuralgic  Toothache,  p.  258.  * 

II.  Tic  Douloureux,  p.  181 ;  254. 

III.  Hemierania,  p.  132  ;   182. 

IV.  Sciatica,  p.  182;  23-5. 
V.  Mastodynia,  p.  171. 

VI.  Intercostal  Neuralgia,  p.  155.  , 

VII.  Neuralgic  Dysraenorrhcea,  p.  99. 
VIII.  Neuralgia  of  Testicle,  p.  251. 
IX.  Neuralgia  of  Rectum,  p.  223. 
X.  Spasm  of  Bladder,  p.  276. 

NOSE   DISEASES: 
I.  Lipoma,  p.  179. 

II.  Polypus,  p.  179. 

III.  Oz»na,  p.  192. 

IV.  Epistaxis,  p.  112. 
V.  Rhinolithes,  p.  231. 

VI.  Rhinorrhcea,  p.  231. 

PANCREATIC   AND   SPLENIC   DISEASE: 
I.  Pancreatitis,  p.  193. 

II.  Pancreatic  Tumors,  Cancer,  &c.,  p.  193. 

III.  Pancreatic  Calculi,  p.  193. 

IV.  Splenitis,  &c.,  p.  244. 

V.  Splenic  Enlargement,  p.  244. 

PHARYNGEAL   AND  (ESOPHAGEAL  DISEASES 

I.  Dysphagia,  p.  101. 
II.  Pharyngitis,  1.  Erysipelatous  Inflammation,  p.  204. 

2.  Syphilitic  Ulceration,  p.  204. 

3.  Elongation  of  Uvula,  p.  204. 

III.  Retro-Pharyngeal  Abscess,  p.  229. 

IV.  CEsophagitis,  p.  185. 


XX 


TABULAR   SYNOPSIS. 


PHAKYNGEAL   AND   (ESOPHAGEAL   BIS^E  AS  ES— (continued): 

V.  Oesophageal  Cancer,  p.  184. 
VI.  Esophageal  Stricture,  p.  184. 
YII.  (Esophagism,  p.  185. 

POISONS  (p.  213): 

I.  Irritants,  p.  213. 

1.  Acids  and  their  Bases,  Mineral  Acids,      Sulphuric, 

Nitric. 

Hydrochloric. 

Mixed  Acids. 
Vegetable  Acids,  Acetic. 

Tartaric. 

Oxalic. 
Phosphorus. 

2.  Alkalies  and  Alkaline  Salts,  Ammonia,  Potash,  Soda,  and  their  carbonates. 

Nitrate,  Sulphate,  and  Bi tartrate  of  Potash. 
Lime,  Baryta  and  its  salts. 

Arsenic. 

Mercury. 

Lead. 

Copper. 

Antimonial  compounds. 

Zinc,  Silver,  Tin,  Bismuth,  Chi'ome,  Iron. 
Vegetable  and  Animal  Irritants. 
Irritant  Gases. 


8.  Metallic  Compounds, 


II.  Narcotics,  p.  213. 

1.  Opium. 

2.  Hydrocyanic  Acid. 

3.  Nitro-Benzole,  Aniline. 

4.  Chloroform,  ^ther,  Amylene. 
6.  Alcohol. 

6.  Henbane,  Lettuce-opium,  Nightshade. 

7.  Narcotic  Gases. 

III.  Narcotico-Irkitants,  p.  213. 

1.  Nux  vomica,  Brucia,  Strychnia. 

2.  Belladonna,  Aconite,  Stramonium,  Colchicum,  Hellebore. 

3.  Digitalis,  Tobacco,  Lobelia  Inflata,  Camphor. 

4.  Hemlock,  Cocculus  Indicus,  Darnel-seeds. 

5.  Laburnum,  Yew. 

6.  Ergot  of  Bye,  Poisonous  Eungi. 


SKIN  APPENDAGES  (Diseases  of ) ; 

I.  Alopecia,  or  Baldness,  p.  35. 
II.  Trichiasis  Ciliorum,  p.  259. 

III.  Onyxis,  p.  18(5. 

IV.  Onychia,  p.  186. 

V.  Verrucas,  or  Warts,  p.  274. 
VI.  Phthiriasis,  or  Lousiness,  p.  206. 
VII.  Trichiniasis,  p.  259. 
VIII.  Dracontiasis,  p.  95. 
IX.  Mycetoma,  p.  176. 


SKIN  DISEASES: 

Order  I.  Exanthemata,  1.  Erythema,  p.  114. 
lloseola,  p.  232. 


Order  II.  Vesiculas, 


2. 

3.  Urticaria",  p.  270. 

1.  Sudamina,  p.  245. 

2.  Miliaria,  p.  176. 

8.  Herpes,  p.  142 ;  284. 
4.  Pemphigus,  p.  201. 
6.  Kupia,  p.  233. 


TABULAR   SYNOPSIS.  XXI 


SKIN    DISEASE  S—{conti7iued) : 

Order  III.  Pustulfc,  1.  Ecthyma,  p.  102. 
2.  Impetigo,  p.  150. 
Order  IV.  Parasitici,  1.   Tinea  Tonsurans,  p.  254. 

2.  Tinea  Favosa,  p.  254. 

3.  Tinea  Decalvans,  p.  255. 

4.  Tinea  Sycosis,  p.  255. 

5.  Tinea  Versicolor,  p.  255, 

6.  Plica  Polonica,  p.  211. 

7.  Scabies,  p.  233. 
Order  V.  Papula3,  1.  Strophulus,  p.  245. 

2.  Lichen,  p.  165. 

3.  Prurigo,  p.  218. 
Order  VI.  Squamae,  1.  Lepra,  p.  164. 

2.  Psoriasis,  p.  219. 

3.  Pityriasis,  p.  209. 

4.  Eczema,  p.  103. 

5.  Ichthyosis,  p.  149. 
Order  VII.  Tubercula,  1.  Barbadoes  Leg,  p.  48. 

2.  MoUuscum,  p.  175. 

3.  Acne,  p.  33. 

4.  Lupus,  p.  167. 

6.  Framboesia,  p.  119. 

6.  Keloid,  p.  162. 

7.  Vitiligo,  p.  277. 


SPINAL   COED   DISEASES: 
I.  Epilepsy,  p.  110. 
II.  Chorea,  p.  72. 

III.  Inflammation,  &c.,  1.  Spinal  Meningitis,  p.  242. 

2.  Cerebro-Spinal  Meningitis,  p.  243. 
8.   Myelitis,  p.  176. 

4.  Spinal  Hemorrhage,  p.  242. 

5.  Tumors,  p.  243. 

6.  Hydrorachis,  p.  147  ;  240. 

7.  Concussion,  p.  76. 

8.  Spinal  Irritation,  p.  242. 

IV.  Paralysis,  1.  General  Paralysis,  p.  194. 

2.  Hemiplegia,  p.  194. 

3.  Paraplegia,  p.  195. 

4.  Local  Paralysis,  p.  195. 
6.  Keflex  Paralysis,  p.  225. 

6.  Progressive  Locomotor  Ataxy,  p.  196. 

7.  Hysterical  and  Rheumatic  Palsy,  p.  197. 

8.  Progressive  Muscular  Atrophy,  p.  197. 

9.  Mercurial  Palsy,  p.  198. 

10.  Lead  Palsy,  p.  198. 

11.  Paralysis  Agitans,  p.  199. 
V.  Catalepsy,  p.  62.     Ecstasy,  p.  102. 

VI.  Tetanus,  1.  Trismus,  or  Locked-jaw,  p.  253. 

2.  Opisthotonos,  p.  253. 

3.  Emprosthotonos,  p.  253. 

4.  Pleurosthotonos,  p.  253. 

5.  Trismus  Nascentium,  p.  260. 
VII.  Convulsions,  p.  80.     Eclampsia  Nutans,  p.  102. 

VIII.  Spina  Bifida,  p.  240. 


STOMACH  DISEASES: 

I.  Dyspepsia,  1.  Simple  Dyspepsia,  p.  100. 

2.  Gastralgia,  or  Heartburn,  p.  121. 

3.  Gastrodynia,  or  Stomach-cramp,  p.  124. 

4.  Pyrosis,  or  Water-brash,  p.  222. 
6.  Slow  Digestion,  p.  100. 

6.  Bulimic  Dyspepsia,  p.  54. 


Xxii  TABULAR   SYNOPSIS. 


STOMACH    DISEASE  S—{co7itinued) : 

II.  Gastritis,  1.  Acute  Gastritis,  p.  122. 

2.  Chronic  Gastritis,  p.  122. 

3.  Gastric  Catarrh,  p.  122. 

4.  Induration  of  Pylorus,  p.  123. 

5.  Dihitation  of  Stomach,  p.  123. 

III.  Gastric  Ulcer,  p.  121. 

IV.  Gastric  Cancer,  p.  121. 

V.  Gastro-cutaneous  Eistula,  p.  124. 
VI.  Gastro-colic  Fistula,  p.  124. 
VII.  Hsematemesis,  p.  128.     Vomiting  and  Retching,  p.  277. 
VIII.  Melaena,  p.  178. 


THYEOID   GLAND   DISEASES: 
I.  Bronchocele,  p.  53. 
II.  Cretinism,  p.  85. 
III.  Exophthalmic  Goitre,  p.  53;   128. 


TONGUE   DISEASES: 

I.  Glossitis,  p.  255. 
II.  Ulcers,  p.  255. 

III.  Cancer,  p.  256. 

IV.  Cracked  Tongue,  Tumors,  &c.,  p.  256. 
V.  Aphthje,  p.  43. 


TOOTHACHE: 

I.  Caries,  p.  258. 
II.  Inflammation  of  Pulp,  p.  258. 

III.  Necrosis  of  Fangs,  p.  258. 

IV.  Neuralgia,  p.  258. 


TUBERCULAR  AND  STRUMOUS   DISEASES: 

I.  Tuberculosis,  p.  260.     Scrofula,  p.  236. 
II.  Phthisis,  p.  206.     Phthisis  Laryngea,  p.  164. 

III.  Hydrocephalus,  p.  145. 

IV.  Tabes  Mesenterica,  p.  2.50. 

V.  Tubercular  Peritonitis,  p.  203. 
VI.  Tubercular  Meningitis,  p.  68. 
VII.  Tuberculosis  of  Liver,  p.  136. 
VIII.  Renal  Tubercle,  p.  228. 
IX.  Strumous  Abscesses,  p.  236. 

X.  Strumous  Adenitis,  p.  34 ;  236. 
XI.  Strumous  Ulcers,  p.  236. 
XII.  Strumous  Ophthalmia,  p.  79. 

XIII.  Scrofulous  Testicle,  p.  253. 

XIV.  Rickets,  p.  232. 

XV.  Angular  Curvature  of  Spine,  p.  241. 


TUMORS  (Benign): 

1.  Polypi,  1.  Nasal,  p.  179. 

2.  Rectal,  p.  224. 

3.  Vaginal,  p.  272. 

4.  Uterine,  p.  269. 
II.  Cerebral  Tumors,  p.  67, 

III.  Intra-Thoracic  Tumors,  p.  158. 

IV.  Spinal  Cord  Tumors,  p.  243. 
V.  Hepatic  Tumors,  p.  136. 

VI.  Tumors  of  Testicles,  p.  251. 
VII.   Mammary  Tumors,  p.  168. 
VIII.  Muscular,  or  Phantom  Tumors,  p.  175. 


TABULAR    SYNOPSIS.  XXlii 


TUMOR  S— (continued)  : 

IX.  Renal  Tumors,  p.  146;  22G ;  228. 
X.  Vesioal  Tumors,  p.  276. 
XI.  Vulviil  Tumors,  p.  279. 
XII.  Vascular  Tumors  of  Urethra,  p.  273. 

XIII.  Vaginal  Tumors,  p.  272. 

XIV.  Ovarian  Tumors,  p.  191. 
XV.  Uterine  Tumors,  p.  268. 

XVI.  Hsemorrhoids,  p.  130. 


ULCERS: 

I.  Cancerous  Ulceration,  p.  56. 

II.  Rodent  Ulcer,  p.  232. 

III.  Scrofulous  Ulcers,  p.  236. 

IV.  Syphilitic  Ulcers,  p.  248. 
V.  Lupus,  p.  167. 

VI.  Typhoid  Ulcers,  p.  261. 

VII.  Varioloid  Ulcers,  p.  238. 

VIII.  Dysenteric  Ulcers,  p.  98. 

IX.  Ulcers  of  Cornea,  p.  82. 

X.  Ulcers  of  Tongue,  p.  256. 

XI.  Gastric  Ulcer,  p.  121. 

XII.  Ulcers  of  Duodenum,  p.  97. 

XIII.  Ulcers  of  Rectum,  p.  225. 

XIV.  Vulval  Corroding  Ulcer,  p.  278. 
XV.  Ulceration  of  Cervix  Uteri,  p.  270. 

XVI.  Chilblains,  p.  69. 

XVII.  Chapped  Hands,  p.  69. 

XVIII.  Onychia,  p.  186. 


VENEREAL  DISEASES   (p.  274) : 
I.  Balanitis,  p.  48. 
II.  Vulvitis,  p.  280. 

III.  Gonorrhoea,  1.  Gonorrhoea  in  Male,  p.  125. 

2.  Chronic  Gonorrhoea,  or  Gleet,  p.  126. 

3.  Gonorrhoea  in  Female,  p.  126. 

IV.  Syphilis,  1.   Primary  Syphilis,  p.  248. 

2.  Constitutional  Syphilis,  p.  248. 
8.  Infantile  Syphilis,  p.  259. 
V.  Bubo,  p.  54. 
VI.  Syphiliphobia,  p.  247. 
VII.  Svphilization,  p.  249. 
VIII.  Syphilitic  Keratitis,  p.  82. 
IX.  Syphilitic  Iritis,  p.  160. 

X.  Gonorrhoeal  Ophthalmia,  p.  78. 
XI.  Syphilitic  Tumors  of  Brain,  p.  67. 
XII.  Syphilitic  Laryngitis,  p.  163. 

XIII.  Syphilitic  Bronchitis,  p.  53. 

XIV.  Syphilitic  Ulceration  of  Fauces,  p.  204. 
XV.  Syphilitic  Affections  of  Tongue,  p.  256 ;  257. 

XVI.  Syphilitic  Hepatitis,  p.  138. 
XVII.  Syphilitic  Sarcocele,  p.  252. 
XVIII.  Syphilitic  Ulceration  of  Labia  Uteri,  p.  270. 
XIX.  Syphilitic  Lepra,  p.  164. 
XX.  Syphilitic  Rupia,  p.  233. 


AN 


INDEX   OF   DISEASES. 


ABSCESS  OF  ABDOMINAL  WALLS.  — Im-oiu  Ah.«Y,fo,  (o  lonn  sm 
:»l>sci'ss:  Ahii,}ni,-ii,  \]\c  lirll\  .--  Mav  rosult  tVoin  i-xtoiMial  violoiu-i".  fiirim- 
cular  intlamiiiation,  niul  orysipolas  ;  ov  iVom  ox  ton  si  on  of  disoaso  in  (>llior 
[tai'ls.  Man\  oxaniplos  ot'  hillor:  Inllaniniation  and  siippiii'alion  of 
voiMnilorni  appendix  ot' ctrciuu,  (ho  pus  workino-  its  wa'y  to  siii-laoo  sonu*- 
wiiore  about  rii;lit  iuii-uinal  rooion. — Su}i]Mirat ivo  intlainniati^ry  action 
apt  to  (H'cur  in  aroolar  t  issuo  of  polvis ;  in  oithor  ovary,  ospot'ially  in 
dolii'alo  and  strumous  wonuMi;  :il>si'i'ss  at'torwarils  points  in  ono  of 
i;roius,  in  hypoi^astrie  roii'ion,  or  in  vagina.  ho\vol,  «!i;c'. — Inllaniniation 
and  suppuration  ot"  adipose  and  ari'oiai'  tissues  around  one  of  Uidiieys 
(perineplu'itie  abseoss)  may  occur  tViun  Mows  or  tiills  ujion  hack,  or 
trom  dei'angenient  of  ijeneral  lieaith.  In  favoralde  cases,  ahsi-ess  ])oin(s 
in  oui"  loin  :  occasionally,  ])us  Imrrows  amongst  dt)rsal  niuscles,  l>ein^ 
ultimately  discharn-ed  into  ui^Mcr,  or  into  cavity  ot"  jteritoneum. —  A  cir- 
cumscribed abscess  may  loiiu  in  pi'ritoneum,  trom  partial  ov  <;-enei'al 
pei'itonit is  :  (he  pus.  contined  by  ailhesions,  either  approai'hes  surface 
at  some  ])art.  of  abdominal  wail  or  bursts  into  sac  of  peritoneum,  or  into 
bowel.  iVc. — In  all  tbrms,  when  ahsi'css  ])c)in(s,  i(,  is  to  hv  caretuHy 
opened.  Strength  to  bo  su])por(ed  by  ammonia  and  bark,  oi-  (piininc 
and  steel:  animal  food,  nulk,  cod-liver  oil,  n\alt  licpiors. — See  (\iiitusiot>ji 
ol'  AhiloDiiiuil   Witlh  ;    Oi'iU-ifis  :    Pel  ric  (\l  hi  litis,  ikv. 

ACHOLIA. —  From  'A,  privative;  x<'^V>  ''''^'-  '^.y»^>-  Alh^ciiCi'  0/  />//«•. — 
Arros(  of  (ho  functions  of  the  liver;  so  (hat  matters  from  which  bilo  is 
formed,  accumnhUe  in  (he  blood,  producing  (oxivsmia. —  It  arises  in  cer- 
tain diseases  of  liver,  such  as  acute  atrophy,  impermeability  oi'  tho 
bile-ducts,  cirrhosis,  extensive  cancer,  fatty  degeneration,  i^c. 

Symi'toms. — Abnormal  states  of  nervous  system.  Kxci(ement.  Noisy 
delirium,  (\)nvulsions.  Typhoid  pros(rati()n.  (\>ma.  llemoi-rhagc 
from  stomach  and  bowels.     Kcchyn\oses.     Jaundici^  (in  a  few  instances). 

Trkaiimknt. — Active  purgatives.  C'i-o(on  oil,  KiS,  IDI.  rodojihy llin, 
D>0.  lienzoii^  acid,  45).  llydrot'ldora(e  of  ammt)nia,  tiO.  JNitro-hydro- 
chloric  acid,  i>7S. — See  Iltpatic  Atrophy. 

ACINESIA. —  From  W,  ])i-iv. ;  xi\^r}<n(;,  motion.  Synon.  Immobilitas ; 
Eriiiiiit. —  Fai'alysis  of  juotion. — See  Pdrah/sis. 

ACNE. — l.'erha|)s  a  corru))tion  of  ^Axfuxi,  pimples  on  the  face  at  the 
age  of  puberty,  or  from  'A,  priv.  and  xviut,  to  itch,  because  there  is  an 

3 


34  Addison's  disease — adenitis. 

absence  of  irritation,  i^ynou.  Gvtta  JRosacea  ;  Copper  Nose ;  Stonepock. — 
A  chronic  tubercular  sliin  affection;  characterized  by  small  isolated 
pustules,  with  deep  red  bases.  These  pustules,  after  suppurating  and 
bursting,  leave  behind  them  minute  and  hard  red  tumors,  the  seat  of 
which  appears  to  be  the  sebaceous  follicles  of  skin. 

Varieties.  Three  kinds, — acne  simplex,  acne  indurata,  and  acne  rosa- 
cea :  characteristic  distinctions  indicated  by  their  names.  Acne  sim- 
plex and  acne  indurata,  most  common  about  puberty;  appear  on  fore- 
head or  sides  of  cheeks;  are  very  protracted  and  frequently  leave  in- 
delible cicatrices.  Acne  rosacea  attacks  the  nose  :  often  connected  with 
stomach  or  liver  disease  :  mostly  seen  in  persons  of  advanced  years, 
especially  if  they  have  been  bons  vivants,  &c. 

Treatment.  Attention  to  digestive  and  uterine  functions.  Arsenic, 
52.  Creasote.  Corrosive  sublimate.  Green  iodide  of  mercury.  Nitro- 
hydrochloric  acid.  Solution  of  potash.  Cod-liver  oil. — Warm  bathing. 
Iodide  of  sulphur  ointment.  Calomel  ointment.  Red  iodide  of  mercury 
ointment. 

ADDISON'S  DISEASE. — Applied  to  a  peculiar  degeneration  of  the 
gupra-renal  capsules.  According  to  Addison  the  prominent  symptoms 
were  discoloration  of  the  skin  and  incurable  anaemia.  It  is  now  said 
that  the  disease  may  exist  without  the  skin  becoming  of  a  dingy  or 
fimoky  hue. — See  Supra-Renal  Capsular  Disease. 

ADENITIS. — From  Mo^^v,  a  gland  ;  terminal  -itis.  Synon.  Phlegmasia 
Glandulosa. — Inflammation  of  the  lymphatic  glands  may  accompany 
disease  of  lymphatic  vessels,  or  it  occurs  independently.  Simple  adenitis 
common  after  eruptive  fevers.  Tubercular  adenitis  very  frequently  met 
with  in  strumous  subjects. 

Symptoms.  Acute  form :  Feeling  of  malaise:  slight  chills:  sympto- 
matic fever.  One  or  more  glands  become  swollen,  hot,  hard,  tender, 
painful.  As  tumefaction  increases,  skin  over  gland  becomes  red  or  livid. 
If  convoluted  tubes  get  obstructed,  surrounding  tissues  rendered  oedem- 
atous.  Unless  resolution  occur,  or  acute  stage  subsides  into  chronic, 
suppuration  takes  place  :  abscess  forms  in  interior  of  gland,  or  in  sur- 
rounding areolar  tissue. 

Chronic  variety :  Induration  with  persistent  enlargement.  Pain  and 
heat  slight.  Skin  retains  its  natural  color.  Areolar  tissue  unaftected, 
so  that  gland  remains  movable. 

Strumous  adenitis:  Usually  chronic.  Glands  of  neck,  and  those  about 
base  and  angle  of  lower  jaw,  more  frequently  affected  than  any  others. 
Subjects  of  this  form  are  especially  young  children,  though  it  is  not  a 
rare  affection  of  sti'umous  adults.  Rarely  any  premonitory  symptoms: 
first  indication  of  the  disease  an  indolent  swelling  of  one  or  more 
glands.  If  mischief  increase,  and  especially  if  there  be  a  tendency  to 
suppuration,  system  suffers  considerably  :  the  already  weak  patient 
becomes  irritable  and  restless,  tongue  gets  furred,  pulse  quick  and 
feeble,  bowels  costive,  appetite  fails,  urine  scanty  and  loaded  with  urates. 
Where  general  health  is  very  bad,  inflamed  glands  rapidly  undergo  dis- 
organization ;  surrounding  areolar  tissue  and  skin  get  involved;  exten- 
sive indolent  ulcers  result.  When  lymphatic  glands  of  the  mesentery 
are  affected  with  strumous  inflammation,  a  special  form  of  disease  is  set 
up  (Tabes  Mesenterica). — For  Syphilitic  adenitis,  see  Bubo.  Malignant 
adenitis,  see  Cancer. 

Treatment.  Carbonate  of  ammonia,  301.  Chlorate  of  potash,  61. 
Ammonia  and  bark,  371.  Quinine,  879.  Quinine  and  steel,  380.  Iodide 
of  ammonium  and  bark,  38.     Phosi^hate  of  iron,  405.     Cod-liver  oil. 


AGALACTIA — AMAUROSIS.  35 

Bromide  of  Mmnionium.  Ilj'drochlorate  of  ammonia.  Conium.  Iodide 
of  iron.  Coi-rosive  sublimate.  Eed  iodide  of  mercur3\  Nourisliing 
food  :  milk  or  cream.  Sea  air.  Water  dressing.  Iodine  liniment.  Dilu- 
ted red  iodide  of  mercury  ointment.     Iodide  of  lead  ointment. 

AGALACTIA. — From  'A,  priv. ;  yd?.a,  milk.  Sj^non.  Defectus  Lactis ; 
Oligogalactia.  A  diminution  or  complete  absence  of  milk  in  nursing 
women.  May  be  caused  by  general  weakness  of  constitution ;  long- 
continued  mental  anxiety ;  exhausting  disease;  general  plethora;  acute 
or  chronic  disease  of  breasts  or  nipples;  torpor  of  the  mammee;  return 
of  menstruation  while  suckling;  approach  of  change  of  life. 

Treat^fent.  Unless  cured,  infant  must  be  weaned  to  prevent  its 
suffering  from  insufficient  nourishment.     See  F.  427. 

AGUE. — From  the  French  Aigu,  acute.     See  Intermitteyit  Fever. 

ALCOHOLISM.  —  Alcohol  is  a  poison  which  especially  affects  the 
nervous  centres  and  liver.  In  a  large  dose  it  ma}"  destroy  life  imme- 
diately.    ^eQ  Delirixim  Treviens ;  Dipsomania;  Poisons. 

ALOPECIA. — From  'A^.w~r^^.  a  fox, — because  this  animal  is  said  to  be 
liable  to  baldness.  Synon.  Capillorvm  Defluvimn ;  Lapsus  Pilonim ;  Bald- 
ness; Cah'ities  (Calvus,  bald). — Loss  of  hair  may  be  temporary  or  per- 
manent. Senile  calvities  usually  takes  place  gradually :  hair  first  be- 
comes thin  on  crown  of  head,  or  on  temples  and  forehead.  A  con- 
sequence of  general  loss  of  power:  hair  follicles  participate  in  general 
weakening  of  nutritive  functions.  As  follicular  apparatus  gets  de- 
stroyed, the  loss  is  generally  irremediable. 

In  baldness  occurring  from  debility,  hemorrhages,  fevers,  tuberculosis, 
syphilis,  &c.,  the  hair  follicles  remain  entire,  though  inactive.  Such 
cases  generally  curable. 

Treatment.  Nourishing  food.  Quinine  and  steel,  380.  Cod-liver 
oil.  Scalp  to  be  well  brushed  :  to  be  washed  with  cold  water  every 
morning.  Hairs  which  are  withered  and  split  to  be  cut  off  close  to 
scalp.  Blisters.  Ammonia  and  cantharides  liniment,  287.  Cantha- 
rides,  castor  oil,  balsam  of  tolu,  &c.,  287.  Iodide  of  sulphur  ointment, 
310.  Creasote  and  sulphur  ointment,  311.  Diluted  iodine  liniment. 
Diluted  liniment  of  cantharides.  Solution  of  ammonia.  Liniment  of 
turpentine  and  acetic  acid.  Balsam  of  Peru.  Glj^cerine.  Oil  of  rose- 
mary (Oleum  Eosmarini).     Oil  of  marjoram  (Oleum  Origani). 

AMAUROSIS. — From  'A/jLaupow,  to  obscure.  Synon.  Gutta  serena. 
Partial  or  complete  loss  of  vision  from  disease  of  brain,  optic  nerve,  or 
retina.  Reflex  amaurosis  due  to  remote  causes, — irritation  of  teething, 
intestinal  worms,  ovarian  or  uterine  disease,  pregnancy,  &c. 

Symptoms.  Patient's  gait  and  expression  of  countenance  attract  at- 
tention. He  walks  with  an  air  of  uncertainty :  his  eyes,  instead  of  being- 
directed  towards  surrounding  objects,  have  an  unmeaning  look — ap^^ear 
to  be  staring  at  nothing.  In  incomplete  amaurosis,  movements  of  iris 
sluggish  and  pupil  dilated:  in  total  blindness,  pupil  greatly  dilated  and 
iris  immovable.  When  both  eyes  are  affected,  they  are  often  unnatu- 
rally prominent  and  of  an  unhealthy  color:  sclerotica  frequently  of  a 
yellow  hue,  and  covered  with  varicose  vessels.  Ophthalmoscope  re- 
veals either, — blood  extravasations  from  retina  or  choroid  ;  or  effusions 
of  serum  between  retina  and  choroid;  or  irregular  patches  of  black 
pigment  scattered  over  retina,  or  yellowish  spots  (fatty  degeneration); 
or  optic  nerve  enlarged  and  irregular  in  outline,  or  surrounded  by  dusky 


36  AMBLYOPIA AMENORRHCEA. 

halo,  or  with  a  crescentic  patch  at  margin,  or  of  an  extreme  whiteness 
(from  degeneration)  with  chronic  congestion  of  retina. 

In  commencement,  failure  of  sight  only  experienced  occasionally,  as 
after  long-continued  exertion  of  the  eyes,  reading  by  candlelight,  &c. 
Sometimes  it  begins  with  indistinct  vision — cnnblyopia ;  or  objects  appear 
double — diplopia;  or  only  one-half  of  an  object  may  be  seen — hemiopia. 
At  same  time,  frequently  headache:  ocular  spectra  become  visible, 
patient  complaining  of  musca)  volitantes. 

Another  form  of  partial  blindness  is  that  in  which  patient  can  only 
see  in  broad  daylight,  being  blind  during  remainder  of  twenty-four 
hours.  This  complaint — heoieralopia — usually  met  with  in  those  who 
have  been  exposed  to  strong  glaring  light  of  tropics.  In  nyctalopia, 
converse  condition  of  hemeralopia,  vision  most  acute  during  twilight. 

Treatment.  Difficult  to  lay  down  rules,  since  the  causes  are  so  va- 
rious and  opposite.  In  all  instances,  attention  to  general  health.  Each 
case  then  to  be  studied  in  all  its  bearings,  especially  with  reference  to 
the  cause.  When  manifestly  resulting  from  reflected  irritation  of  worms, 
decayed  teeth,  &c.,  treatment  obvious.  When  from  inflammation, — 
strict  quiet,  warm  baths,  and  low  diet  may  be  necessary:  iodide  of  po- 
tassium; aconite;  arnica;  calomel?;  bloodletting.  When  from  vascu- 
lar exhaustion  or  nervous  debility, — preparations  of  iron,  bark,  good 
diet,  sea  air,  and  cold  bathing.  Strychnia,  in  some  few  examples,  may 
stimulate  a  torpid  optic  nerve  itito  action.  Electricity  acts  in  same 
way.  Counter-irritants  behind  ears,  or  to  nape  of  neck,  or  to  shaven 
scalp.    W^here  there  is  degeneration  of  optic  nerve  all  remedies  useless. 

AMBLYOPIA. — From  '  J,a/?Au?,  obtuse  or  dull ;  m(/',  the  eye.  Synon. 
Diminished  Acuteness  of  JRetitial  Perception.  Weakness  of  sight  from 
disease  of  brain,  of  optic  nerve,  or  of  retinal  expansion  of  optic  nerve. — 
See  Amaurosis. 

AMENORRHCEA. — From  'A,  priv. ;  /7.r^v,  a  month;  piw,  to  flow. — An 
absence  of  the  menstrual  flow.     Two  varieties: 

1.  Retention  of  Menses. — The  catamenia  are  secreted,  but  do  not 
escape  externally.  May  arise  from  occlusion  of  vagina;  from  an  im- 
perforate OS  uteri.  Menses  accumulate  in  uterine  cavity,  forming  in 
time  an  appreciable  abdominal  tumor.  An  outlet  must  be  made  for  the 
menstrual  accumulation  by  very  cautiously  incising  or  puncturing  ob- 
structing membrane.  If  no  spot  or  dimple,  marking  site  where  os  uteri 
should  exist,  can  be  found,  it  may  be  necessary  to  puncture  uterus 
through  rectum.     All  such  operations  attended  with  danger. 

2.  Suppression  of  Menses. — Most  common  form  of  amenorrhoea.  The 
flux  having  been  properly  established,  and  having  appeared  regularly 
for  a  longer  or  shorter  time,  becomes  prematurely  arrested. 

May  occur  suddenly,  while  discharge  is  on,  from  mental  shock,  set- 
ting in  of  acute  disease,  exposure  to  damp  or  cold.  Takes  place  gradu- 
ally; flow  not  returning  at  proper  time,  or  becoming  less  and  less  for 
several  periods,  and  then  entirely  stopping.  More  constitutional  dis- 
turbance in  abrupt  than  gradual  suppression.  Latter  most  to  be  feared, 
as  often  indicative  of  more  serious  cause  (severe  ansemia,  2)hthisis,  al- 
buminuria, &c.).     Care  necessary  not  to  overlook  pregnancy. 

Treatment. — If  there  be  plethora  :  Nitric  acid,  taraxacum,  and  senna, 
147.  Aloes,  senna,  and  suli)hate  of  magnesia,  150.  Gamboge,  aloes, 
and  blue  pill,  174.  Podophyllin  and  aloes,  422.  Nitre,  spirit  of  juniper, 
and  nitrous  ether,  221.  Iodide  of  potassium,  31.  Aloes  and  savin  pessary, 
423.     Enema  of  aloes.     Bromide  of  potassium  and    cantharides,  422. 


AMNESIA — AMYLOID    DEGENERATION.  37 

Ergot  of  rye.  Hot  hip  baths.  Mustard  pediliivia.  Three  or  four 
leeches,  repeated  at  intervals  to  cervix  uteri.  Sinapisms  to  breasts. 
Turkish  baths.  Simple  diet.  Avoidance  of  stimulants.  If  there  be 
ana'mia :  Steel  and  aloes.  154,  393,  404.  Steel  and  ammonia,  401. 
Quinine  and  steel,  380.  Steel  and  pepsine,  394.  Spirit  of  juniper  and 
acid  tartrate  of  potash,  219.  Oil  of  juniper,  229.  Iodide  of  iron,  32. 
Iodide  of  iron  and  nux  vomica,  421.  Oil  of  rue  and  ergot  of  r3-e,  422. 
Valerianate  of  steel,  savin,  and  assafcetida,  421.  Mustard  pediluvia. 
Galvanism.  Nourishing  food.  Brandy;  gin;  wine.  AVaters  of  Spa, 
467.     Ems,  486.     Schwalbach,  488.     Eger,  498. 

AMNESIA. — From  M,  priv. ;  ijyy,(nq^  remembrance.  Synon.  Ohlivio ; 
Meiu()ri<t  Dcleta. — Forgetfulness,  or  loss  of  memory.  A  prominent  symp- 
tom in  certain  cerebral  diseases,  ttc. 

AMYLOID  DEGENERATION.— From  Awijhm.  starch:  JDegenero,  to 
degenerate. — The  discover}'  in  the  animal  kingdom  of  starch,  or  of  a 
substance  which  possesses  properties  allied  to  those  of  amylaceous  group 
in  vegetable  world,  is  full  of  interest.  For  some  years  it  has  been 
known  that  the  liver,  spleen,  and  kidneys,  occasionally  undei'go  a  de- 
generation, which  has  been  described  as  Lardaceous,  Waxy,  Cholesterine, 
or  Albuviinous  Infiltration  ;  though  until  the  researches  of  Virehow  (1854 
-1859),  practitioners  wei'e  ignorant  of  the  nature  of  this  substance,  as 
well  as  of  its  exact  seat.  In  the  human  body  there  are  to  be  found 
two  allied,  but  not  identical,  substances: 

(1)  Bodies  which,  in  their  chemical  properties,  are  analogous  to  real 
vegetable  starch,  and  in  their  form  bear  an  extraordinaiy  resemblance 
to  vegetable  starch-granules,  inasmuch  as  they  constitute  more  or  less 
round  or  oval  structures,  formed  by  a  succession  of  concentric  layers. 
To  this  class  belong  the  little  corpora  amylacea  of  nervous  system  ; 
laminated  bodies  found  in  prostate  of  every  adult  man,  and  which, 
under  certain  circumstances,  accumulate  in  large  quantities,  so  as  to 
form  prostatic  concretions;  and  rare  forms  of  a  similar  kind  which 
occur  in  certain  conditions  of  lungs. 

(2)  In  foregoing  cases  the  starch-like  matter  lies  between  the  elements 
of  the  tissues.  Very  different  are  those  cases  where  there  is  a  degene- 
ration of  the  tissues  themselves, — where  their  component  parts  become 
filled  with  a  starch-like  or  amj'loid  substance.  The  change  begins  in 
the  muscular  fibre-cells  of  middle  coat  of  small  arteries  :  walls  of  ves- 
sels get  gradually  thickened,  while  their  calibre  diminishes.  Then  the 
morbid  process  involves  surrounding  anaemic  parenchj'ma;  extending 
until  the  whole  tissue  in  neighborhood  of  arteries  is  altered.  Several 
organs  are  generally  invaded  simultaneously,  and  rendered  incapable 
of  performing  their  functions.  Patients  gradually  assume  a  cachectic, 
broken-down  appearance;  lose  flesh  and  strength;  dropsy  often  super- 
venes; urine  gets  albuminous  if  kidneys  be  affected;  diarrhoea  sets  in 
when  digestive  tract  is  involved ;  and  in  spite  of  remedies  death  soon 
takes  place. 

When  liver,  spleen,  or  kidnej^s  are  organs  affected,  an  unpractised 
eye  may  fail  to  detect  alteration  in  structure  unless  there  be  an  extreme 
amount  of  disease.  When  a  liver  is  incised  where  amyloid  degeneration 
is  far  advanced,  a  feeling  is  communicated  like  that  experienced  on 
passing  a  knife  through  wax  :  cut  surface  presents  a  semi-transparent 
appearance.  The  gland  is  increased  in  size;  has  some  resemblance  to 
a  fatty  liver,  though  its  greater  weight  distinguishes  it ;  a  sense  on 
handling  is  given  like  that  received  from  a  lump  of  wax;  and  if  disease 
be  very  extensive,  no  trace  of  normal   structure  can  be  distinguished, 


38  ANASARCA — ANGEIOLEUCITIS. 

though  in  an  earliei'  stage  the  lobules  are  seen  distinctly  mapped  out, 
owing  to  the  matter  being  deposited  within  the  lobule  and  in  and  among 
secreting  cells. 

Amyloid  degeneration  may  exist  alone,  or  in  connection  with  tuber- 
culosis, disease  of  bones,  and  syphilis.  Thus,  in  phthisis,  this  form  of 
hepatic  disease  is  probably  more  common  than  fatty  liver;  while 
sometimes  amyloid  and  fatty  degeneration  occur  together.  So  fre- 
quently has  amyloid  degeneration  been  found  connected  with  caries  or 
necrosis,  that  it  was  thought  the  osseous  disease  exercised  some  deter- 
mining influence  on  production  of  amyloid  bodies.  Multiplied  researches 
have  proved,  however,  that  amyloid  degeneration  is  as  frequently  asso- 
ciated with  phthisis  and  sj'philis,  as  with  bone  disease.  So  it  was  con- 
sidered that  Bright's  disease  was  often  associated  with  amyloid  degen- 
eration, until  the  discover}'  that  the  former  was  sometimes  merely  a 
symptom  of  the  latter  aifecting  kidneys. — See  Hepatic  Degenerations ; 
Renal  Degenerations,  &c. 

ANASARCA. — From  'Ava,  through  ;  adp^,  the  flesh.  Synon.  Hydrops 
Cellularis  Totius  Corporis;  Hydrosarca ;  General  Dropsy. — The  more  or 
less  general  accumulation  of  serum  in  the  meshes  of  the  areolar  tissue 
throughout  the  body. 

Treatment.  Compound  Jalap  powder.  Compound  scammonj-  pow- 
der. Elaterium,  157.  Acid  tartrate  of  potash,  228.  Chimaphila  umbel- 
lata,  221.  Digitalis  and  squills,  219.  Oil  or  spirit  of  juniper,  229.  Col- 
chicum.     Tartaratod  iron. 

Warm  bath.  Turkish  Bath.  Bloodletting.  Dry  cupjjing  to  loins. 
Acupuncture.     Issues.  See  CEdema;  Dropsy. 

ANMMIA. — From  'A.  priv. ;  ai/ia,  blood.  Synon.  Exmnia ;  Spanoiinia; 
Hydra'iiiia  ;  Oligemia.  Deficiency  or  poverty  of  blood.  The  red  globules, 
instead  of  existing  in  the  proportion  of  180  per  1000  parts  of  blood,  as 
in  health,  are  reduced  to  80,  60,  or  even  less.  The  liquor  sanguinis  is 
also  poor  in  albumen,  and  ma}'  contain  an  excess  of  salts. 

Symptoms.  A  pale,  waxy,  blanched  appearance  of  integuments  and 
mucous  membranes.  Feeble,  rapid  pulse.  Anorexia.  Aortic  bellows- 
sound.  Bruit  de  diable  in  jugular  veins.  Enlargement  of  thyroid. 
Proptosis  oculi.  Attacks  of  fainting.  Palpitation  and  dyspnoea. 
Oedema,  and  dropsical  effusions  into  pleura,  pericardium,  or  peritoneum. 
Amenorrhea.     Occasionally,  latal  syncope  or  coma. 

Treatment.  Iron,  380,  392,  393,  404,  412.  Chemical  food,  405.  Bark, 
371,  376.  Binoxide  of  manganese.  Aloetic  aperients,  with  or  without 
steel,  148,  393,  404.  Pepsine,  394,  420.  Peroxide  of  hydrogen  increases 
the  power  of  ferruginous  tonics.  Inhalation  of  oxygen.  Alkaline  hypo- 
phosphites.  Nourishing  food:  Milk;  raw  eggs;  brandy  and  egg  mix- 
ture, 17;  restorative  soup,  raw  meat,  2;  essence  of  beef,  3;  malt  flour, 
&c.,  as  in  Liebig's  food,  4;  fish;  poultry;  roast  beef  and  mutton  ;  bitter 
ale;  wine.  Cod-liver  oil.  389.  Sea  air.  Mineral  waters  of  Spa,  467. 
Schwalbach,  488.     Bruckenau,  493.     Franzensbad,  498.    See  Chlorosis. 

ANESTHESIA.— From  M  priv.;  alffdrLo/jM,  to  feel.  Synon.  Anal- 
gesia.— Paralysis  of  sensibility. — See  Paralysis. 

ANGEIOLEUCITIS. — From  "Ayyslov,  a  vessel ;  hoxth,  white ;  terminal 
-itis.  Synon.  Lt/ntp/iangifis ;  Tnjianimatio  Vasorum  Lynipliaticorum.  In- 
flammation of  tiie  lym])hatic  vessels  may  result  from  external  injury, 
or  from  absorption  of  some  morbid  matter — as  in  dissection  wounds, 
unhealthy  carbuncles,  ko,.     Lymphatic  glands  usually  involved. 


ANGINA    PECTORIS — AORTIC   ANEURISM.  39 

Symptoms.  Formation  of  bris^lit  red  strenks;  runnino;  upwards  from 
wound  in  course  of  absorbents,  to  tlie  jrlands  in  which  the  vessels  merge. 
Streaks,  tender  to  touch;  the  seat  of  stinging  pains;  hard,  like  little 
cords.  G-lands  in  connection  with  affected  vessels  (piickly  become  in- 
volved:  get  swollen  and  acutely  painful.  Whole  limb  rendered  i)uffy 
and  tender.  Great  constitutional  disturbance  :  chills  or  rigors  ;  nausea 
and  constipation,  fever,  restlessness,  mental  and  bodily  prostration. — 
May  end  in  resolution  ;  suppuration ;  chronic  induration;  fatal  exhaus- 
tion, or  ichorhffmia.     Often  complicated  with  erj^sipelas,  or  phlebitis. 

Treatment.  Sulphite  of  soda  or  magnesia,  48.  Chlorate  of  potash, 
61.  Carbonate  of  ammonia,  361.  Ammonia  and  bark,  371.  Quinine, 
379.  Hydro(!hloric  acid,  357.  Purgative  enemata,  188,  190.  Essence 
of  beef,  3.  Eestorative  soup,  2.  Eggs,  cream,  and  extract  of  beef,  5. 
Brandy  and  egg  mixture,  17.  Wine.  Ice.  Acid  tartrate  of  potash 
drink,  356.  Hydrochloric  acid  and  chlorate  of  potash  drink,  358. — Fo- 
mentations. Linseed  poultices.  Extract  of  belladonna  and  water  dress- 
ing. Bed  to  be  placed  in  centre  of  well-ventilated  room.  Evacuation 
of  pus  by  free  incisions. 

ANGINA  PECTORIS.— From  "Ay/'^,  to  strangle :  Pectus,  the  breast. 

Synon.  Orthopima  Cardiaca ;  Cardioneuralgia ;  Suffocative  Breast-pang. — 
A  disease  in  which  severe  pain  is  felt  about  the  chest,  with  a  sense  of 
strangulation  and  great  anxiety. — Occurs  most  frequently  in  advanced 
life.  More  common  in  men  than  women.  Has  been  found  associated 
with  fatty  degeneration  of  heart ;  but  more  usually  in  connection  with 
diseased  coronary  arteries.  ^ 

Symptoms.  Paroxysms  of  intense  pain  about  prrecordial  region  ;  feel- 
ing of  suffocation  ;  fearful  sense  of  impending  death.  Seizure  rarely 
lasts  more  than  one  or  two  minutes.  May  come  on  at  any  time :  if  pa- 
tient be  walking  he  is  obliged  to  stop  immediately.  During  attack, 
pulse  slow  and  feeble;  breathing  short  and  hurried;  countenance  pale 
and  anxious  ;  surface  of  body  cold,  perhaps  covered  with  clammy  SAveat; 
consciousness  unimpaired.  As  struggle  passes  off,  patient  regains  his 
usual  health;  often  appears  quite  well. — If  death  do  not  occur  in  an 
early  seizure,  it  generally  does  so  in  some  subsequent  attack. 

Treatment.  During  paroxysm  :  Brandy  or  wine.  Ether,  chloroform,, 
and  ammonia,  85.  Hydrocyanic  acid,  soda,  and  morphia,  70.  Bella- 
donna. Camphor.  Assafo^tida.  Sinapisms.  Turpentine  stupes.  Fric- 
tion.    Flying  blisters. 

During  interval :  Animal  food  ;  milk  or  cream  ;  light  wines.  Ammonia 
and  bark,  371.  Mineral  acids  and  bark,  376.  Quinine  and  steel,  380. 
Quinine  and  belladonna,  383.  Steel  and  pepsine,  394.  Phosphate  of 
iron,  405.  Zinc  and  nux  vomica,  409.  Valerianate  of  zinc  and  bella- 
donna, 410.  Sulphate  of  zinc  and  aconite,  413.  Phosphate  of  zinc,  414. 
Arsenic.  Sulphur.  Quinine.  Belladonna  plaster  over  pra'cordia.  An 
issue  at  nape  of  neck.  Avoidance  of  stimulants,  strong  exercise,  walk- 
ing soon  after  meals,  sexual  intercourse,  and  mental  excitement. 

ANOREXIA.— From  A,  priv.;  o/>£?:?,  appetite.  Synon.  Inappetentia. — 
Loss  of  appetite  is  a  common  symptom  in  most  diseases.  When  present 
without  apparent  cause,  attempts  must  be  made  to  give  tone  to  digestive 
organs.  Mineral  acids,  pepsine,  rhubarb,  aloes,  quinine,  salicine,  and! 
bitter  vegetable  tinctures  or  infusions  are  the  chief  remedies. 

AORTIC  ANEURISM.— From  \4oprrj,  the  great  artery :  'Aveupwu),  to 
dilate. —  Varieties  :  True  aneurism,  in  which  all  the  coats  of  artery  dilate 
and  unite  in  forming  walls  of  pouch  ;  false  aneurism,  in  w^hich  inner  and 


40  AORTIC    ANEURISM. 

middle  ai'terial  tunics  being  ruptured,  walls  are  formed  by  cellular  coat 
and  contiguous  parts  ;  and  mixed  or  consecutive  false  aneurism,  in  which 
the  three  coats  having  at  first  dilated,  inner  and  middle  ones  subse- 
quently rupture  as  distension  increases.  When  the  two  inner  tunics  are 
ruptured,  and  blood  forces  its  way  between  them  and  outer  coat  by  a 
kind  of  false  passage,  so  as  to  form  a  spreading  diffused  tumor,  disease 
known  as  a  dissecting  aneurism.  Lastly,  varicose  aneurisms  are  those 
where  a  communication  has  formed  between  aorta  and  either  of  the 
vente  cava^,  or  between  aorta  and  one  of  auricles,  or  between  this  vessel 
and  right  ventricle,  or  between  aorta  and  pulmonary  artery. 

Aortic  aneurism  a  disease  of  advanced  life,  rather  than  of  youth  : 
often  results  from  ossific  or  calcareous  deposits,  or  from  atheromatous 
or  fatty  degeneration  of  coats  of  vessel,  and  consequently  other  vessels 
are  not  uncommonly  found  affected  at  same  time.  When  tumor  is 
small,  its  existence  frequently  goes  undetected.  Death  generally  results 
from  hemorrhage  owing  to  rupture  of  sac;  or  sudden  death  may  occur 
"without  any  rupture  (as  from  suffocation);  or  there  may  be  gradual 
sinking  from  exhaustion  caused  by  long-continued  suffering,  or  from 
debility  brought  about  b}^  repeated  escape  of  small  quantities  of  blood, 
or  from  coexistent  tubercular  consumption. 

1.  Aneurism  of  Thoracic  Aorta. — Chiefly  met  with  in  ascending  por- 
tion, or  in  transverse  part  of  arch. 

Symptoms.  In  early  stage  obscure,  partly  because  they  resemble 
those  caused  by  heart  disease.  When  tumor  is  of  some  size,  and  has 
been  quickly  developed,  there  is  disturbed  action  of  heart,  with  some 
modification  of  radial  pulse ;  superficial  veins  of  chest  and  neck  are 
turgid;  one  or  both  upper  extremities  oedematous;  dulness  on  percus- 
sion around  portion  of  vessel  from  which  aneurism  springs;  cough, 
wheezing,  dyspnoea,  hjemoptysis,  difficulty  in  swallowing,  and  jDain 
about  the  chest  and  back.  Latter  most  constant  and  severe  when 
erosion  of  bones  of  spine  or  sternum  or  ribs  is  going  on. — Supposing 
aneurismal  tumor  becomes  very  large  and  pulsating,  and  rises  out  of 
chest,  producing  protrusion  or  absorption  of  sternum  and  ribs,  then 
the  diagnosis  is  easy.  When  the  sac  presses  upon  trachea,  there  are 
dyspnoea  and  cough;  when  on  one  or  both  recurrent  laryngeal  nerves, 
aphonia  with  troublesome  cough,  severe  paroxysms  of  laryngeal  suffo- 
cation, and  pain  coming  on  at  intervals;  w^hen  on  oesophagus,  dysphagia 
and  symptoms  of  stricture;  when  on  thoracic  duct,  inanition  and  en- 
gorgement of  absorbent  vessels  and  glands.  Where  an  aneurism  of 
ascending  aorta  is  in  immediate  neighborhood  of  the  heart,  patient 
suffers  from  angina  pectoris ;  probably  to  be  referred  to  compression  of 
great  plexuses  of  nerves  ramifying  on  either  side  of  ascending  aorta, 
and  communicating  freely  with  the  cardiac  ganglia  and  plexuses  of  the 
ventricles  (Dr.  W.  T.  Gairdner). 

Amongst  other  S3nnptoms, — conti-action  or  dilatation  of  pupil  on 
affected  side;  according  as  pressure  is  sufficient  to  paralyze,  or  only 
irritate,  branches  of  sympathetic  nerve. — Sometimes  a  beilows-sound 
<jan  be  detected.  If  the  heart  be  compressed  by  tumor,  so  as  to  impede 
normal  action  of  valves,  a  sj'stolic  or  diastolic  bruit  will  result.  Pres- 
sure on  aorta,  or  on  pulmonar}^  artery,  may  also  produce  a  murmur.  In 
false  aneurism  there  is  generally  a  murmur  both  with  entrance  and  exit 
of  blood  into  sac;  or  there  may  be  one  loud  and  prolonged  and  rasping 
bruit,  from  passage  of  blood  over  roughened  inner  surface  of  vessel.  In 
true  aneurism  or  mere  dilatation  of  a  part  of  the  wall,  murmurs  seldom 
audible.  Nevertheless,  a  small  but  free  opening  from  canal  of  artery 
into   aneurismal  sac,   and   a  roughened   state  of    arterial  tunics  from 


AORTIC   ANEURISM — AORTITIS.  41 

degeneration  or  from  atheromatous  deposit,  will  give  rise  to  a  bruit. 
In  both  foi-ms,  when  a  murmur  exists,  a  ijeculiar  thrilling  or  purring 
tremor  will  be  felt  over  sternum. 

Death  may  occur  from  ru])ture  externally,  or  into  pericardium,  into 
either  pleural  cavity,  into  trachea,  or  into  a  bronchial  tube.  Or  patient 
may  die  from  exhaustion  consequent  on  long-continued  suffering.  Or 
there  may  be  fatal  destructive  inflammation  of  lung,  owing  to  compres- 
sion of  pulmonary  vessels,  or  to  pressure  on  pneumogastrie  nerve. — Very 
rarely,  cure  has  resulted  from  solidification  of  fibrine. 

Treatment.     The  same  as  for  Aneurism  of  Abdominal  Aorta. 

2.  Aneurism  of  Abdominal  Aorta. — Often  gives  rise  to  acute  pain  in 
lumbar  region,  shooting  into  either  hj'pochondrium  and  downwards 
into  thighs  and  scrotum.  Pain  aggravated  by  constipation :  often 
relieved  by  l.ying  on  face.  A  tumor  discovered  by  careful  examination  : 
constant  and  powerful  pulsation  communicated  to  hand.  A  short,  loud, 
abrupt  bellows-sound  will  be  heard. 

Treatment.  General  Rules  :  In  aortic  aneurism,  all  bodily  and  mental 
excitement  must  be  avoided.  Pain,  cough,  dyspnoea,  and  other  jjrom- 
inent  symptoms  to  be  alleviated.  Generous  reparative  diet  to  be 
allowed:  sheny,  Bordeaux,  Rhine,  or  Hungarian  wines;  brandy  or 
"whiskey  and  water ;  avoidance  of  malt  liquors.  Attention  to  be  paid  to 
digestive,  secreting,  and  excreting  functions. 

Curative  :  Iodide  of  potassium,  in  lai'ge  doses,  31.  Acetate  of  lead,  in 
gradually  increasing  doses,  ])erhap8  up  to  tw^enty  grains  dail.y;  with 
acetic  acid.  lodo-tannin.  Tinctui'e  of  perchloride  of  iron,  101.  Am- 
moniated  iron  alum,  116.  Locally:  Ice.  Electricity.  Electro-puncture. 
Belladonna  plasters.  Puncture  with  a  small  tx'oear  and  canula,  and 
introduction  of  fine  iron  wire  through  latter,  so  as  to  afford  an  exten- 
sive surface  on  which  fibrine  may  coagulate  (Murchison  and  Moore).  In 
abdominal  aortic  aneurism,  pressure  with  a  tourniquet  for  several  hours, 
patient  being  kept  under  influence  of  chloroform  (William  Murray). 
Valsalva's  plan  of  frequent  bleedings,  while  patient  is  kept  on  lowest 
possible  diet,  not  to  be  recommended. 

Ptdliative :  Opium.  Morphia.  Subcutaneous  injection  of  morphia. 
Belladonna.  Digitalis.  Indian  hemp.  Camphor.  Assafoetida.  Spirit 
of  ether  or  chloroform.  Mercury,  digitalis,  and  squills.  Tracheotomy^, 
if  suffocation  threaten.  Small  bleedings,  where  there  is  great  pulmo- 
nary congestion. 

AORTITIS. — From  'Aapri],  the  great  artery;  tei-minal -2Y«s.  Synon. 
Inflainmatio  Aorta'. — Acute  inflammation  of  aorta  a  very  rare  affection. 
Probably  a  blood  disease :  allied  to  rheumatism,  like  pericarditis  and 
endocarditis. 

Symptoms.  Very  obscure.  General  uneasiness.  Rigors  followed  by 
fever.  Orthopnoea,  with  frequent  sense  of  suffocation.  Pain  and  vio- 
lent pulsation  in  vessel.  Great  palpitation.  Sometimes,  a  loud  S3'stolic 
bruit.     Pulse  often  unaffected. 

Coats  of  aorta  may  undergo  structural  changes;  either  as  result  of 
chronic  inflammation,  or  of  a  simple  degeneration  of  tissues.  Mineral 
or  ossific,  amyloid,  and  atheromatous  or  fatty  degenei^ations,  most  fre- 
quently met  with  in  advanced  life,  although  thej^may  occur  at  an  earlier 
period. 

Treat.ment.  Iodide  of  potassium.  Colchicum.  Aconite.  Opium. 
Spirit  of  ether.  Spirit  of  chloroform.  Warm  baths.  Dry  cupping  over 
sj)ine.     Ice  to  spine.     Blisters, 


42  APHASIA — APHONIA. 

APHASIA. — From  'J,  priv. ;  <pd(n^,  speech. — A  loss  of  the  cerehral 
faculty  of  speech  ;  and  (in  most  cases)  of  the  power  of  expressing  the 
thoughts  by  writing  and  gestures.  In  other  words, — a  simultaneous  loss, 
in  a  greater  or  lesser  degree,  of  the  memory  of  words,  the  memory  of 
the  acts  b}^  means  of  which  words  are  articulated,  and  of  intelligence 
(Trousseau). 

Aphasia  sometimes  transitory,  as  occasionally  during  convalescence 
from  severe  attack  of  fever,  when  it  ma}'  be  owing  to  cerebral  conges- 
tion. It  may  be  permanent,  and  due  to  softening  of  brain,  or  to  cere- 
bral hemorrhage.  Some  physiologists  have  tried  to  prove  that  the 
faculty  of  expressing  thought  b}'  speech  is  seated  in  the  posterior  por- 
tion of  the  third  frontal  convolution  of  the  brain,  chiefly  on  the  left  side. 
Clinical  experience  disproves  this  theory.  Aphasia  with  hemiplegia, 
especially  of  right  side,  is  the  most  common  form.  In  all  cases  there  is 
a  tendency  to  apoplexy. 

Symptoms.  Sudden  deprivation  of  powder  of  speech.  Perhaps,  in  a 
short  time,  one  or  two  words  can  be  uttered,  which  are  then  spoken  in 
reply  to  all  kinds  of  questions.  Face  intelligent.  Movements  of  lips 
and  tongue  and  lar^'nx  healthy.  There  may  be  consciousness  of  what 
is  wished  to  be  expressed,  and  jqX  complete  inabilit}"  to  express  the 
thoughts  by  speech,  gesture,  or  even  (frequently)  by  writing.  Aphasic 
patients  know  the  use  of  objects  (such  as  spoons,  night-caps,  pipes,  &c.), 
though  they  cannot  name  them.  Moreover,  they  can  often  play  cor- 
rectly at  cards,  backgammon,  dominoes,  &c.  They  can  perhaps  read; 
but  if  the}'  understand  what  they  peruse  they  forget  directly,  as  they 
will  pore  over  the  same  page  again  and  again. 

The  case  related  by  Trousseau,  of  a  Eussian  gentleman,  resident  in 
Paris,  forms  a  good  example  of  aphasia.  Mr.  T.  spoke  French  like  a 
Parisian,  yet  after  his  attack  was  unable  to  speak  a  word  of  French. 
\Yhen  questioned,  he  smiled  and  said  "f/a,"  a  Eussian  word  meaning 
yes.  He  was  unable  to  construct  even  part  of  a  sentence  in  his  own 
language.  When  shown  a  spoon  he  could  make  gestures  showing  its 
use:  and  yet  had  forgotten  its  name  in  Eussian  and  French.  Never- 
theless, he  could  play  at  whist  correctly,  and  noticed  any  errors  of  his 
adversaries  by  making  a  gesture.  In  another  example,  a  j'oung  man 
25  years  old,  was  attacked  with  hemiplegia  of  right  side  and  aphasia. 
Some  power  of  moving  right  leg,  and  then  of  arm,  returned;  but  he 
could  only  articulate  two  words,  No  and  Mamma.  "  What's  your  name?" 
— "  Mamma."  "What's  your  age?" — "  Mamma,  no."  Yet  he  knew  that 
his  reph'  was  incorrect.  He  had  taught  himself  to  wi'ite  Avith  his  left 
Ijand,  as  far  as  signing  his  name.  He  wrote  this  legibly.  But  on  being- 
told  to  say  "  Cxuenier,"  as  he  had  written  it,  he  made  an  eft'ort  and  said 
'•Mamma."  ''Say  Henri,"  and  he  replied,  "jSTo,  mamma."  On  being- 
told  to  write  "mamma,"  he  wrote  '•  Guenier."  "Write  no;"  and  he 
again  wrote  "  Guenier." 

Treatment.  In  eases  of  aphasia  without  hemiplegia  recovery  may 
occur  spontaneously.  Probaby  any  kind  of  treatment  (by  drugs,  bleed- 
ing, or  blistering)  is  injurious.  In  aphasia  with  hemiplegia,  medicine  is 
powerless  to  eff'ect  a  cure ;  save  in  cases  dependent  on  syphilis,  when 
iodide  of  potassium  is  the  remed}'. 

APHONIA. — From  'A.  priv.;  (pw^rj,  the  voice. — Loss  of  voice,  from 
organic  or  functional  disease  of  vocal  cords,  varies  in  degree  from  a 
slight  impairment  to  complete  dumbness.  It  is  either  temporary  or 
permanent. 

Varieties.  A])honia  may  be  due  either  to  functional  disorder,  or  to 
structural  change. 


APHTHA    OF   MOUTH — APOPLEXY.  43 

fl)  Functional  variety  :  Tlysterical  aphonia  t3'pical.  Generally  allied 
with  other  symptoms  indicative  of  its  nature.  In  women,  uterine 
functions  frequently  disturbed  :  irritation  of  one  or  both  ovaries  often 
present.  Leucorrhoea:  amenorrhoea,  or  sometimes  menorrhagia. — Pa- 
tient speaks  in  a  whisper  for  days  together.  Then  power  returns,  but 
relapses  are  common. — Aphonia  from  fright  occurs  in  men  as  well  as 
in  women. — If  functional  aphonia  be  of  long  continuance,  the  vocal 
cords  will  probabl}"  become  flaccid  and  powerless.  An  examination  by 
laryngoscope  shows  a  paralytic  condition  of  cords.  Faradization  very 
useful. 

(2)  Organic  form :  Caused  by  inflammation,  serous  infiltration,  ul- 
ceration of  mucous  membrane  about  vocal  cords;  conditions  detected 
by  larj-ngoscope.  May  also  arise  from  pressure  of  morbid  growths 
in  or  near  larynx:  disease  of  brain,  producing  paralysis  of  muscles  of 
larynx,  on  normal  action  of  which,  the  tension  and  position  of  vocal 
cords  depends. 

Treatment.  If  functional :  Quinine  and  steel,  380.  Quinine  and 
nux  vomica,  387.  Compound  iron  mixture  with  aloes,  393.  Phosphate 
of  iron,  405.  Strychnia  and  steel,  408.  Zinc  and  nux  vomica,  409. 
Valerianate  of  zinc,  410.  Nourishing  food.  Galvanism.  Spray  of 
astringent  fluids,  262.     Shower  baths.     Moral  influence. 

When  organic:  For  cure  of  inflammation  and  ulceration  about  vocal 
cords,  sponging  with  solution  of  nitrate  of  silver  (gr.  40  to  fl.  oz.  j). 
Spray  of  astringent  fluids,  262.  Scarification,  in  cedema  of  glottis.  Re- 
moval of  polypi,  or  other  growths,  by  wire  ecraseur.  Ferruginous  tonics. 
Cod-liver  oil,  &c. — For  loss  of  the  faculty  of  expressing  the  thoughts 
by  speech,  see  Aphasia. 

APHTHA  OF  MOUTH.— From  "Ar^zm,  to  fasten  upon.  Synon.  Sto- 
matitis  Exudativa ;  2Iuguet;  Thrush. — Aphtha?  consist  of  small,  round, 
white,  elevated  specks  or  patches,  scattered  over  tongue  and  lining 
membrane  of  mouth,  and  sometimes  extending  down  oesophagus.  Forms 
a  special  disorder  in  infanc}' — the  thrush:  in  adult  age,  aphtha?  often 
produced  in  course  of  prostrating  disease. — Two  microscopical  parasitic 
plants — Leptothrix  buccalis  and  Oidiurn  albicans — developed  in  large  quan- 
tity, in  and  between  epithelial  cells  of  mucous  membrane:  filaments 
and  spores  of  these  fungi  render  e]>ithelium  friable,  loose,  and  swollen. 

Symptoms.  Restlessness.  Debility.  Cough.  Difficulty  in  swallow- 
ing. Vomiting.  Diarrhoea.  Where  aphthous  spots  are  abundant  they 
may  coalesce,  forming  a  dirty  diphtherial-looking  membrane. 

Treatment.  Application  of  borax  and  gljx-erine,  250.  Application 
of  sulphite  of  soda  (gr.  60  to  water  fl.  oz.  j).  Mild  astringents.  Bark 
and  port  wine.  Chemical  food,  405.  Cod-liver  oil.  Chlorate  of  pot- 
ash.    Pure  milk.     Liebig's  food,  4.     Restorative  soup,  2.     Beef  tea. 

APOPLEXY. — From  'J-o,  by  means  of;  -XrjfTffto,  to  strike, — because 
those  attacked  fall  down,  as  if  from  a  blow. — A  state  of  coma,  occurring 
suddenly  from  pressure  on  the  brain,  the  compressing  power  having  its 
seat  within  the  cranium.  There  is  sudden  loss  of  sensation,  thought, 
and  power  of  voluntary  motion;  with  more  or  less  severe  disturbance 
of  respiration  and  circulation. 

Warnings.  Apoplexj^  seldom  occurs  without  some  previous  threaten- 
ings,  such  as :  Headache  and  giddiness,  experienced  particularly  on 
stooping;  feeling  of  weight  and  fulness  in  head;  noises  in  ears,  tempo- 
rary deafness ;  transient  blindness,  or  sometimes  double  vision  ;  repeated 
e])istaxis;  fits  of  nausea;  occasional  sense  of  numbness  in  limbs;  loss 
of  memory;  great  mental  depression;  incoherent  talking;  drowsiness; 


44  APOPLEXY. 

indistinctness  of  articulation  ;  and  partial  paralysis,  affecting  a  limb,  or 
muscles  of  face,  or  eyelids. 

Certain  individuals  predisposed  :  Those  whose  ancestors  suffered  from 
it;  men  of  a  peculiar  habit  of  body,  of.sedentarj-  habits,  accustomed  to 
high  living,  with  protuberant  bellies,  large  heads,  florid  features,  and 
short  thick  necks ;  and  individuals  advanced  in  life,  beyond  fifty.  A 
predisposition  also  engendered  by  disease  of  kidneys,  heart,  or  cerebral 
bloodvessels;  by  intemperance  ;  and  by  cessation  of  habitual  dischai"ges. 

Varieties.  The  comatose  condition  may  cease  in  one  of  three  ways: 
It  maj'  gradually  pass  off,  leaving  patient  well;  or  it  may  terminate  in 
incomplete  recover^^,  mind  being  impaired,  and  some  parts  of  body 
paralyzed;  or  it  may  end  in  death.  In  latter  case,  on  examining  the 
brain,  we  find  either  no  appearance  whatever  of  disease,  or  extravasated 
blood  is  discovered  in  ventricles,  or  pons  Varolii,  or  to  large  amount  in 
centrum  ovale  majus,  or  in  sac  of  arachnoid  ;  or  there  is  copious  effusion 
of  serum  into  ventricles  or  beneath  arachnoid,  with  or  without  cerebral 
softening.  That  which  is  fatal  without  leaving  any  traces  is  nervous  or 
simple  apoplexy;  the  second,  sanguineous  apoplexy,  or  cerebral  hemor- 
rhage; the  third,  serous  apoplex}'.  Apoplex}^  niay  also  result  from 
embolism.  During  life  it  may  be  impossible  to  distinguish  hy  the  symp- 
toms these  varieties. 

Modes  op  Seizure.  Commences  in  three  different  waj^s :  In  first, 
patient  falls  down  sudden!}^;  deprived  of  sense  and  motion;  lies  like  a 
person  in  deep  sleep.  Face  generalh^  flushed.  Breathing  stertorous. 
Pulse  full  and  not  frequent,  occasionally  below  natural  standard.  Some- 
times convulsions;  or  rigiditj^  and  contraction  of  muscles  of  limbs, 
perhaps  only  on  one  side  (Abercrombie). 

In  second  form,  coma  not  the  first  symptom.  Complaint  made  of 
sudden  pain  in  head.  Pallor,  sickness,  faintness.  Sometimes  vomiting. 
Frequently,  patient  falls  to  ground  in  a  state  resembling  syncope.  Oc- 
casionall}',  instead  of  falling,  the  sudden  pain  is  on!}'  accompanied  by 
slight  and  ti*ansient  loss  of  consciousness.  After  a  few  hours,  headache 
eontinuing,  he  becomes  heavy  and  oppressed  and  forgetful:  gradually 
sinks  into  complete  coma,  from  which  recovery  is  rare.  A  large  clot 
usually  found  in  brain. 

Third  variety  begins  by  symptoms  of  cerebral  hemorrhage.  There 
is  an  attack  of  paralysis  of  one  side:  sometimes  deprivation  of  power 
of  speech,  but  no  loss  of  consciousness.  The  paralysis  may  pass  into 
coma;  or  it  mnj  remain  without  further  urgent  sym]>toms;  or  it  may 
elowly  go  off  and  patient  recover:  or  it  may  pass  off  and  death  occur 
suddenly  some  hours  or  days  subsequentl}',  fi'om  return  of  hemorrhage 
(see  Cerebral  Hemorrhage). 

Phenomena  durinot  Fit.  Duration  of  apoplectic  fit  varies  from  two 
or  three  hours  to  as  many  days.  There  is  total  unconsciousness.  Pulse, 
at  first  generally  small,  becomes  full  and  strong,  according  as  system 
recovers  from  shock;  it  is  usualh' slower  than  natural,  sometimes  in- 
termitting. Respiration  slow,  embarrassed,  often  accompanied  b}^  ster- 
tor:  frothy  saliva  about  mouth. — In  bad  cases,  body  covered  with  cold 
clammy  sweat;  face  pale;  eyes  dull  and  glassy,  with  dilatation  of  one 
or  both  pupils  according  as  pressure  is  on  one  or  both  sides;  teeth 
firmly  clenched,  and  all  power  of  deglutition  lost,  or  much  impeded ; 
stertorous  breathing.  Bowels  torpid,  or  motions  passed  involuntarily. 
Involuntary  micturition  ;  or  retention  of  urine,  until  bladder  becomes 
distended  and  overflows,  causing  urine  to  be  constantly  dribbling  away. 
When  patient  recovers  incompletely,  more  or  less  paralysis  of  limbs 
often  remains. 

Treatment,     Prophylactic :  Where  predisposition  is  suspected,  it  is 


ASCITES.  45 

necessary  to  warn  patient  against  sti'ong  l)odily  exertion;  venereal 
excitement;  stimulus  and  irritation  of  any  approach  to  drunkenness; 
heavy  meals;  violent  mental  emotion;  exposure  to  extremes  of  tem- 
perature;  constipation  and  straining  at  stool;  long-continued  stooping; 
tight  neckcloths ;  and  hot  baths.  Diet  to  be  moderate.  Bed-room  to 
be  cool  and  well-ventilated:  to  sleep  on  a  mattress,  with  head  high. 
Daily  exercise  in  open  air.  Head  to  be  washed  in  morning  with  cold 
water.  Where  there  is  giddiness,  or  epistaxis,  or  headache,  or  throb- 
bing of  arteries  of  head,  a  few  doses  of  an  active  purgative  will  be 
useful :  perhaps  blisters  or  seton  to  na])e  of  neck.  Leeches  to  sides  of 
anus,  where  the  threatening  seems  due  to  the  suppression  of  some  ac- 
customed discharge.  Where  there  is  anremia,  bai'k,  and  mineral  acids, 
or  small  doses  of  steel;  with  good  easily  digested  food,  and  plenty  of 
milk.  Arsenious  acid  (gr.  g'^j — j'^  twice  daily)  in  combination  with 
licpior  potassas  has  been  recommended,  on  the  supposition  that  it  reduces 
the  excess  of  red  globules  in  the  blood. 

Curative:  The  rule  is,  after  an  attack,  "to  obviate  the  tendency  to 
death."  (Cullen.)  If  tendency  be  towards  death  by  coma;  if  pulse  be 
full,  hard,  or  thrilling ;  if  vessels  of  neck  are  congested  ;  if  face  be  flushed 
and  turgid, — general  bleeding,  or  cupping  from  nape  of  neck,  may  be 
called  for.  Contrariwise,  if  patient  be  dying  from  s^-ncope,  with  a  feeble 
or  almost  imperceptible  pulse,  and  a  cold  clammy  skin, — then  bleeding 
will  only  insure  a  speedily  fatal  termination.  Bleeding  sometimes  em- 
ployed to  prevent  increase  of  extravasation  ;  but  it  is  probable  that  this 
remedy  promotes  further  loss,  as  it  induces  greater  thinness  of  blood 
and  diminishes  power  of  coagulation. 

Patient  to  be  removed  into  a  cool  and  well-ventilated  room.  Head 
to  be  raised.  All  tight  parts  of  dress  to  be  loosened,  especially  cravat 
and  shirt  collar.  Cold  to  the  head,  by  means  of  pounded  ice  in  a  blad- 
der. If  power  of  swallowing  remain,  calomel  and  jalap,  followed  by 
common  black  draught,  140.  Where  deglutition  is  impossible,  two  or 
three  drops  of  croton  oil  on  back  part  of  tongue.  Stimulating  and  pur- 
gative enemata,  189,  190,  191.  Pediluvia  containing  mustard.  Blisters 
to  scalp,  or  nucha,  seldom  of  benefit  in  any  stage  and  never  at  early 
period.    Emetics  only  useful  where  attack  is  due  to  overloaded  stomach. 

In  event  of  recovery  :  Great  care  needed  to  prevent  a  second  fit.  Strong- 
medicines,  great  excitement,  severe  mental  occupation  to  be  avoided. 
Simple,  but  nutritious  diet :  animal  food  :  milk.  Light  French,  German, 
or  Hungarian  wines. 

ASCITES. — From  M^zo?,  a  wine-skin  or  leather  bottle, — because  of  the 
swollen  condition  of  the  belly.  Sj'non.  Hydrops  Abdominis ;  Hydroperi- 
toneum ;  Dropsy  of  the  Peritoneum. — Consists  of  a  tense  swollen  condition 
of  abdomen,  owing  to  presence  of  a  watery  fluid  in  cavity  of  serous 
lining. 

May  arise  from, — chronic  peritonitis;  cirrhosis,  cancer,  obliteration  of 
portal  vein,  and  amyloid  degeneration  of  liver,  causing  obstruction  to 
free  passage  of  blood  through  system  of  vena  portse ;  renal  disease  and 
albuminuria;  disease  of  heart  or  aorta;  disease  and  enlargement  of 
spleen;  malignant  affections  of  omentum;  and  a  few  more  simple  dis- 
orders,— congestion  of  kidneys,  functional  derangement  of  heart,  an- 
aemia.    Cirrhosis  of  liver  and  renal  disease,  most  common  causes. 

Symptoms.  Characteristic  appearance  of  patient.  Upper  part  of  body 
wasted,  features  pinched,  countenance  very  anxious:  abdomen  greatly 
enlarged,  integuments  shining,  superficial  veins  dilated.  Fluctuation  : 
resonance  on  percussion.     In  advanced   stage,  dyspnoea :  resjjiratory 


46  ASTHENOPIA — ASTHMA. 

murmur  cannot  be  heard  as  low  down  as  in  liealth  :  tubular  breathing 
in  interscapular  regions,  especially  towards  left :  apex  of  heart  elevated, 
and  rather  pressed  to  the  left.  Comnionl}"  anasarca  of  lower  extremi- 
ties: more  rarely,  especially  in  renal  dropsy,  oedema  of  face  and  arms. 
"Urine  scanty,  often  loaded  with  urates  :  in  ascites  from  cirrhosis  it  gen- 
erally contains  bilej  in  that  from  renal  disease,  albumen.  Increasing 
deterioration  of  general  health.  Weakness  and  emaciation.  Loss  of 
appetite.  Sleeplessness.  Inability  to  lie  down.  Exhaustion:  ending 
fatallj'  when  the  dropsy  is  due  to  organic  disease. 

Treatment.  Compound  powder  of  jalap.  Acid  tartrate  of  potash. 
Pill  of  colocynth  and  hyosc^'amus.  Elaterium,  157.  Eesin  of  podophyl- 
lum, 160.  Croton  oil,  168.  Gamboge  with  aloes  and  blue  pill,  174.  Cal- 
omel and  jalap,  159.  Acetate  of  potash,  squills,  and  broom,  219.  Solu- 
tion of  jDOtash,  nitrous  ether,  and  digitalis,  220.  Spirit  of  juniper,  nitrous 
ether,  and  winter-green,  221.  Digitalis  and  squills,  with  blue  pill  or 
taraxacum,  219,  224.  Urea.  225.  ^Nitric  acid,  nitrous  ether,  and  taraxa- 
cum, 147.  Acid  tartrate  of  potash  and  buchu,  222.  Nitrate  of  potash 
and  nitrous  ether,  212.  Conium,  digitalis,  and  calomel.  230.  Hydro- 
chlorate  of  ammonia,  60.  Iodide  of  potassium,  31.  Iodide  of  iron,  82. 
Corrosive  sublimate,  27.  Nitro-hydrochloric  acid,  378.  Colchicum,  46. 
Tincture  of  pcrchloride  of  iron.  Phosphate  of  iron,  405.  Quinine  and 
steel,  380.  Steel  and  ammonia,  401,  403.  Warm  baths.  Tapor  baths. 
Turkish  bath.     Tapping.     Acupuncture.     Issues. 

As  a  rule,  in  dropsy  from  renal  disease,  all  preparations  of  mercury 
are  injurious,  and  diuretics  must  be  emplo3-ed  cautiously:  baths  espe- 
cially useful.  Mercurials  pernicious  where  there  is  anaemia:  compound 
jalap  powder,  hot-air  baths,  and  preparations  of  steel  very  valuable. — 
See  Dropsy.  ' 

ASTHENOPIA.— From  "A,  priv. ;  ff^^voc,  strength ;  w^',  the  eye?  Weak- 
sighteduess,  from  fatigue  of  muscular  system  of  accommodation.  Synon. 
Muscular  Amaurosis. 

Symptoms.  The  eyes  appear  normal.  Inability  to  read  or  write  for 
any  length  of  time :  letters  become  indistinct,  and  words  seem  to  run 
into  each  other.  The  eyes  ache  or  get  ver}'  tired.  Muscje  volitantes. 
Headache.     If  unrelieved,  the  ej^es  become  useless  for  continued  work. 

Treatment.  When  dependent  on  hypermetropia.  ma}'  be  cured  by 
proper  use  of  convex  glasses.  If  due  to  anaemia, — ferruginous  tonics, 
sea-air,  good  food,  cold  water  douche,  and  spectacles  of  sufficient  power. 
Work  to  be  interrupted  every  half-hour  by  rest,  so  long  as  fatigue  is 
induced. 

ASTHMA. — From  'AtrO/jJXuj,  to  gasp  for  breath.  Synon.  Spasmi(S  Bron- 
chialis. — A  nervous  disease:  phenomena  dependent  on  tonic  contraction 
of  circular  muscular  fibres  of  bronchial  tubes.  Paroxysms  induced  by 
direct  or  reflex  mechanism,  i.  e. — the  stimulus  to  contraction  may  be 
central,  in  medulla  oblongata;  or  it  will  be  in  pulmonary  or  gastric 
portion  of  pneumogastric,  or  in  some  other  part  of  nervous  system  be- 
sides the  vagus,  and  being  transmitted  to  medulla  oblongata  by  inci- 
dent, is  thence  reflected  by  motor  filaments. 

Symptoms.  A  fit  of  asthma  is  preceded  either  by  headache  and 
sleepiness,  or  by  various  digestive  or  other  disturbances,  or  it  occurs 
suddenl}'  without  warning.  Patient  awakes  two  or  three  hours  after 
midnight  with  sensation  of  suffocation  or  constriction  about  chest: 
dyspnoea  increases,  until  there  is  a  most  painful  struggle  for  breath. 
Various  postures  assumed  to  facilitate  respiration.  Chest  gets  dis- 
tended to  utmost  limit :  there  is  evidently  some  obstruction  to  entrance 


ASTHMA.  47 

and  exit  of  air.  On  auscultation,  no  respirator}'  murmur  audible;  but 
sibilant  rhonchi,  loud  wheezings,  or  shrill  whistlings  are  heard.  Pulse 
becomes  small  and  feeble.  Eyes  staring.  Countenance  anxious.  Lips 
purple.  Temperature  of  surface  often  falls  to  82='  F.;  but  after  a  time 
the  fatigue  causes  the  skin  to  be  bathed  in  a  hot  sweat.  After  a  longer 
period,  relief  comes.  Cough,  with  expectoration  of  little  pellets  of 
mucus.     Paroxysm  ceases,  and  sufferer  falls  asleep. 

J)uring  interval  between  attacks,  moderately  good  health  enjoyed, 
with  quiet  breathing.  Most  asthmatics  thin  and  round  shouldered: 
countenance  expressive  of  attacks  of  suffering;  cheeks  hollow ;  voice 
rather  hoarse;  slight  cough.  Interval  varies  in  length  from  tw^enty- 
four  hours  to  twelve  months.  Attacks  sometimes  periodic.  Asthma 
very  capricious:  kept  off  by  certain  climates,  but  only  experiment 
can  decide  which  air  is  suitable  for  each  case.  More  common  in  men 
than  women.  Often  hereditary.  In  idiopathic  or  spasmodic  asthma, 
the  disease  is  uncomplicated.  In  symptoniatic  or  organic  asthma,  the 
suffering  is  complicated  with,  or  symptomatic  of,  some  disease  of  nerv- 
ous system,  of  alimentary  canal,  of  heart,  of  lungs,  or  even  of  skin. 

Treatment.  Dui'ing  paroxysm  :  If  stomach  contain  undigested  food, 
a  stimulating  emetic,  232.  If  rectum  be  loaded,  an  enema  of  castor  oil 
and  assafoetida  and  rue,  189.  Croton  oil  and  turpentine  enema,  191. 
Great  object  is  to  relax  bronchial  spasm.  A  dose  of  iodide  of  potassium 
(grs.  10),  with  ammonia  or  ether,  and  tincture  of  belladonna  (min.  xx 
— xxx),  often  succeeds.  Subcutaneous  injection  of  atropine,  314.  Opium 
or  morphia  often  injurious:  if  given,  only  a  full  dose  will  be  of  any, 
avail,  but  the  author's  experience  leads  him  to  forbid  it.  A  cup  of 
strong  coffee.  A  glass  of  strong  brandy  or  whiskey  or  rum  punch.  In- 
halation of  chloroform,  or  ether,  of  doubtful  value  :  patient  usually  gets 
relief  while  inhalation  is  continued,  but  wakes  up  as  bad  as  before. 
Iodoform,  338.  Tobacco  useful  in  some  eases,  especially  in  w'omen : 
when  it  produces  nausea  and  collapse,  the  attack  often  ceases.  A  pipe 
of  Latakia  sufficient  for  those  unaccustomed  to  smoking.  Stramonium 
cigars.  Stramonium  seeds  smoked  in  a  pipe.  Datura  Tatula  cigars. 
Cigares  Anti-Asthmatiques  de  M.  Joy.  Stramonium  with  henbane,  323. 
Conium  with  henbane,  335.  JSitre-paper  fumes.  Turpentine  stupes. 
Hot-water  stupes.     Sinapisms.     Hemlock  poultice. 

In  interval:  Improvement  of  general  health  by  tonics;  regular  mode 
of  life ;  use  of  cold  shower  or  sponge  bath.  Eemoval  of  dj-spejisia. 
Meals  to  be  taken  at  such  times  that  digestion  may  be  completed  be- 
fore retiring  to  bed.  Selection  of  a  climate  the  opposite  to  that  in 
which  attacks  come  on. 

When  mucous  membrane  about  fauces  is  relaxed, — Tannin  or  catechu 
lozenges.  Atomized  spray  of  astringent  fluids,  202.  Sponging  with 
solution  of  nitrate  of  silver. — If  digestion  be  weak, — Nitro-hydrochloric 
acid,  378.  Pepsine,  420.  Ammonia  and  bitters,  361.  Quinine  and 
rhubarb,  385.  Steel  and  citrate  of  potash,  403. — If  periodic.  Quinine. 
Arsenic. — If  cause  be  obscure, — Iodide  of  potassium  with  aconite,  or  with 
ammonia  and  belladonna,  31.  Inhalation  of  oxygen  gas.  Eespiration 
of  compressed  air. 

Remedies  sometimes  employed :  Garlic  (Allium  sativum).  Bulb  of  com- 
mon onion  (Allium  cepa).  Carbonate  of  ammonia.  Ammoniacum  mix- 
ture. Compound  squill  pill.  Assafoetida.  Nitrate  of  silver.  Arsenic. 
Camphor.  Musk.  Galbanum.  Ipecacuanha.  Dilute  hydrocyanic  acid. 
Indian  hemp.  Petroleum.  Senega.  Strychnia.  Storax.  Compound 
tincture  of  benzoin.  Sumbul.  Oxide  of  zinc.  Valerianate  of  zinc  or 
ammonia.  Sulphate  of  zinc.  Blisters  to  spine  or  nucha.  Ointment  of 
tartarated  antimony  to  chest  walls.     Issues.     Galvanism. 


48  ASTIGMATISM — BARBADOES    LEG. 

ASTIGMATISM. — From  'J,priv.;  ariyim^  a  point, — signifying  that  rays 
derived  from  one  point,  do  not  again  unite  into  one  point. — An  ine- 
quality in  the  refractive  power  of  the  several  meridians  of  the  eye. 
The  asymmetr}^  on  which  astigmatism  depends  is  jjroper  to  all  eyes. 
Usualh'  it  exists  in  so  slight  a  degree,  that  the  acuteness  of  vision  is 
not  essentially  impaired  by  it  (normal  astigmatism).  But  exceptionally 
it  becomes  considerable,  and  occasions  an  aberration  of  the  rays  of  light, 
which  interferes  with  the  sharj^ness  of  sight  (Bonders). 

ATELECTASIS.— From  ' ATtXr^q,  imperfect;  exraff;?,  dilatation.— A  con- 
genital non-expansion  of  air-cells  of  lungs. — See  Pulmonary  Condensa- 
tion. 

BALANITIS. — From  BdXaw^,  the  glans  penis;  terminal  -itis — from 
" Itj/m,  to  impel,  and  signifj'ing  inflammation  when  added  to  the  Greek 
name  of  an  organ.  Synon.  External  Clap ;  Gonorrhoea  Pra^putialis. — 
Consists  of  inflammation,  with  redness  and  patches  of  excoriation,  of 
the  glans  penis  and  internal  surface  of  the  prepuce.  Sometimes  the 
afl^ection  is  termed  balanitis  when  only  the  glans  is  affected;  balano- 
posthitis  {BoJm'mi^  -6<rO-ri.  the  skin  covering  the  glans,  terminal  -itis). 
being  applied  when  the  lining  of  the  prepuce  is  also  involved.  This 
refinement  unnecessary:  the  two  conditions  are  rarely  seen  apart. 

Symptoms.  Heat  and  itching  about  the  glans.  A  niuco-])urulent 
discharge.  On  denuding  the  glans,  patches  of  redness  and  excoriation 
perceived,  perhaps  with  flakes  of  curd-like  matter.  If  there  be  cedema 
of  foreskin,  or  the  orifice  of  this  covering  be  contracted,  retraction  may 
be  impossible — phimosis.  Necessity  of  drawing  back  the  foreskin, 
there  may  be  a  chancre,  or  an  abscess,  or  mortification  may  be  threat- 
ening. Sympathetic  bubo  may  arise.  Sometimes  complicated  Avith 
gonorrhoea.  Balanitis  from  inoculation  with  secondary  syphilitic  dis- 
cbarge, may  cause  constitutional  infection. 

A  similar  disorder — vulvitis — occasionally  met  with  in  women,  or 
female  children. 

Treatment.  Great  cleanliness.  Lightly  touching  of  inflamed  surface 
with  nitrate  of  silver.  Astringent  lotions, — alum,  subacetate  of  lead, 
siilphate  of  zinc,  &c.  Mere  washing  and  drying  of  part,  twice  in  24 
hours,  with  separation  of  glans  from  prejiuce  by  a  thin  laj^er  of  cotton- 
wool. Circumcision.  Slitting  up  of  prepuce.  Dilatation  of  preputial 
opening  with  sponge  tents.  After  retraction  of  foreskin  it  is  again  to 
be  drawn  forwards,  to  avoid  paraphimosis. 

BAEBADOES  LEG. — Synon.  Elephantiasis  Arabum ;  Glandular  Dis- 
ease of  Barbadoes  ;  Bucnomia  Tropica. — Characterized  by  great  swelling 
and  induration  of  true  skin,  or  derma.  Produces  most  marked  deformity. 
Sometimes  subjacent  areolar  and  adipose  tissues  are  implicated.  Most 
frequently  attacks  lower  extremities:  swelling  so  great  that  limb  be- 
comes double  its  natural  size.  Hardness,  severe  pain,  and  thickening; 
with  an  appearance  resembling  the  leg  of  an  elephar)t,  whence  the  disease 
has  unfoi-tunately  derived  one  of  its  names  (EXicpa:;,  the  elephant).  The 
scrotum  not  an  uncommon  seat  of  it.  Earely  met  with  in  Europe: 
occurs  principal!}^  in  West  Indies.  Generally  continues  tor  life;  causes 
alarming  constitutional  disturbance  ;  neither  contagious  nor  hereditary- ; 
attacks  males  and  females,  rich  and  poor,  indiscriminately.  When  con- 
fined to  one  foot  and  leg,  amputation  has  been  resorted  to  with  advan- 
tage. Ligature  of  main  artery  of  limb.  The  success  which  has  followed 
removal  of  large  scrotal  tumors  in  India  is  very  remarkable. 


BED    CASE BITES    OF    RABID    ANIMALS.  49 

BED  CASE. — A  not  uncommon  form  of  hysteria.  Subjects  of  it  live 
in  bed;  they  are  tranquil,  cheerful,  have  good  digestions,  and  like  the 
kind  attentions  of  sympathizing  friends.  Often  impressed  with  belief 
that  there  is  serious  disease  in  spine,  or  in  womb:  there  are  certain 
movements  which  they  think  cannot  be  made  without  "horrible"  ])ain. 
Menstruation  frequently  attended  with  suffering;  leucorrhoea. — Amongst 
examples  of  this  pseudo-disease  which  have  come  under  author's  ob- 
servation, the  most  marked  was  that  of  a  single  lady,  thirty-four  years 
of  age,  who  first  consulted  him  in  1861.  This  patient  had  then  been 
confined  to  her  room,  and  almost  to  bed,  for  ten  years.  Had  been 
treated  for  spinal  disease;  taken  large  quantities  of  medicine;  leeches, 
blisters,  setons,  &c.,  had  been  freely  used.  On  examination  every  part 
of  her  body  was  found  health}^  with  exception  of  uterus,  which  was 
retroflexed.  By  replacing  this,  and  by  galvanism  to  long  inactive 
muscles,  a  cure  was  effected ;  but  great  patience  was  needed  to  get  her 
from  bed  to  sofa,  from  sofa  to  chair,  from  chair  to  crutches,  and  so  on 
until  at  the  end  of  three  months  she  could  walk  out  in  open  air.  Some 
cases  can  be  cured  in  a  much  shorter  time.  Each  example  varies  in 
regard  to  important  mental  peculiarities,  and  tact  is  needed  to  persuade 
patient  to  get  well. — See  Hysteria. 

BERIBERI. — From  Beri  the  Singalese  for  weakness,  by  iteration 
implying  great  weakness.  Synon.  Bad  Sickness  of  Ceylon. — A  form  of 
general  dropsy  almost  unknown  to  pathologists  in  this  country.  It  is 
very  fatal  to  European  and  native  troops  at  Ceylon. 

Symptoms.  Increasing  weakness.  Marked  anaemia.  Anxiety.  ISTumb- 
ness  of  the  surface.  Stiffness  and  oedema  of  lower  extremities.  Dyspnoea. 
Paralysis.  Suppression  of  urine.  Effusion  of  serum  into  pleurae  and 
pericardium.     Exhaustion.     Generally  death. 

Treatment.  Elaterium.  Calomel  and  squills.  Squills  and  digitalis. 
Treeak  Farook,  an  electuary  much  esteemed  in  parts  of  India,  the 
ingredients  of  which  are  unknown,  but  which  acts  as  an  aperient  and 
mild  diuretic  when  combined  with  rhubarb:  the  dose  is  from  grs.  5  to 
15.  Oleum  nigrum,  regarded  as  a  valuable  prej^aration  in  India;  hav- 
ing stimulant  and  diaphoretic  properties  in  doses  of  ten  minims.  Tonics. 
Tincture  of  perchloride  of  iron.  Effervescing  draughts.  Opium.  Nux 
Vomica.     Spirit  of  nitrous  ether.     Nourishing  diet.     Wine. 

Bleeding.  Cupping  over  spine.  Blisters.  Friction,  with  stimulating 
liniments.     Galvanism. 

BILIARY  CALCULI.— From  Bilis,  bile :  Calculus  (dimin.  of  calx),  a 
small  stone. — See  (Tall-Stones. 

BITES  OF  RABID  ANIMALS.— The  immediate  treatment  is  as  fol- 
lows: The  tissues  around  seat  of  injury  are  to  be  compressed  by  a 
ligature  or  otherwise,  to  prevent  absorption.  Then  the  wounded  part 
is  to  be  excised  as  soon  as  possible;  taking  care  to  remove  every  portion 
touched  by  animal's  teeth,  and  to  obtain  a  clean  raw  surface.  The 
wound  should  next  be  thoroughly  washed  by  a  stream  of  water,  long 
poured  over  it;  lunar  caustic  afterwards  to  be  applied.  Mr.  Youatt 
prefers  nitrate  of  silver  freely  used,  to  every  other  caustic :  he  recom- 
mends that  after  its  application  the  wound  be  quickly  healed.  Some 
authorities  advise  that  the  wound  be  kept  open  by  irritating  ointments. 
Chloroform  may  be  given  to  prevent  pain  of  knife.  Subsequently, 
patient  to  be  assured  that  all  has  been  done  to  prevent  any  after  mis- 
chief. To  afford  him  greater  confidence,  administer  for  some  days  the 
sulphite  of  magnesia  in  bark,  48. — See  Hydrophobia. 

4 


50  BITES    OF    VENOMOUS    REPTILES — BOILS. 

BITES  OF  VENOMOUS  REPTILES.— The  poisonous  reptiles  provided 
.  with  fangs  are  the  ophidia  or  serpents.  Chief  foreign  serpents :  (1) 
Cerastes  or  Horned  Serpents,  allied  to  vipers,  and  much  to  be  dreaded. 
(2)  Crotali  or  Rattle  Snakes,  provided  with  long  poison  fangs,  and  a 
reservoir  of  some  size.  In  human  subject,  the  poison  is  fatal  in  two  or 
three  minutes.  (3)  Bothrops  or  Javelin  Snakes,  inhabitants  of  Martinique 
and  St.  Lucia.  The  most  formidable  species  is  the  yellow  viper  of  Mar- 
tinique. M.  Guyon  saw  several  soldiers  perish  from  its  bite.  Death 
may  occur  almost  immediately,  or  in  the  course  of  twenty-four  hours. 
And  (4)  Naia,  or  Spectacled  Serpents,  or  Hooded  Snakes,  which  are  met 
with  in  Arabia  and  India.  This  group  contains  the  coluber  haje,  the 
true  asp  of  the  ancients:  also  the  cobi-a  di  capello. 

The  only  poisonous  reptile  indigenous  to  this  country  is  the  Common 
Viper  or  Adder.  It  is  found  on  the  heaths  and  in  the  dry  woods  of  all 
parts  of  Great  Britain.  Poison  apparatus  consists  of  a  gland  placed  by 
side  of  head,  a  duct,  and  a  fang  or  pointed  curved  tooth  moulded  in 
form  of  a  tube.  The  bite  rarely  proves  fatal.  The  wounded  part  be- 
comes the  seat  of  severe  pain;  great  swelling,  redness,  and  lividity. 
Faintness  :  rapidity  and  feebleness  of  pulse.  Bilious  vomitings.  Dysp- 
noea.    Profuse  cold  sweats.     Jaundice.     Delirium,  or  convulsions. 

Treatment.  Locally :  The  wound  to  be  immediately  sucked  freely 
and  perseveringly.  If  patient  is  too  faint  to  do  this  for  himself,  a  by- 
stander can  fearlessly  help  him  :  it  is  well  known  that  these  ])oisons 
may  be  swallowed,  or  smeai'ed  upon  the  lips  and  tongue  (provided  there 
is  no  abrasion),  with  impunity.  At  same  time  a  ligature  is  to  be  placed 
around  the  limb,  above  the  wound;  or  if  this  be  impossible  from  its 
situation,  the  textures  around  are  to  be  compressed.  Then,  the  bitten 
part  to  be  excised;  or  it  may  be  destroyed  by  actual  cautery,  nitric 
acid,  strong  liquor  ammonia?,  or  nitrate  of  silver. 

Constitutionally :,  Remedies  derived  chiefly  from  class  of  diffusible 
stimulants.  No  agent  more  generally  recommended  than  ammonia. 
Compound  tincture  of  ammonia  (Phar.  Lond.),  formerly  known  as  eau 
de  luce,  in  half-drachm  doses  well  diluted;  or  aromatic  spirits  of  am- 
monia, two  drachms  to  an  ounce-and-a-half  of  water.  Supposing  no 
ammonia  is  at  hand,  brandy  will  prove  an  excellent  substitute.  Trans- 
fusion of  blood  has  been  recommended. 

SLACK  LEG. — A  form  of  purpura,  which  occurs  amongst  the  lumber- 
men on  the  Ottawa  or  Grand  River  of  Canada.  It  is  produced  by  the 
use  of  pork  packed  in  nitrate  of  potash. — See  Purpura. 

BLENNOREHAGIA. — From  jSXiwa,  mucus  or  slime ;  pTjyvu/u,  to  burst 
forth.  A  discharge  from  the  mucous  membrane  of  the  urethra  or  va- 
gina, usually  contracted  in  sexual  intercourse. — See  Gonorrhoea. 

BLENNOEEHCEA. — From  i^Xiwa,  mucus ;  piw,  to  flow. — See  Gonorrhoea, 

Gleet. 

BLOWS  AND  BEUISES. — Seldom  necessary  to  do  more  than  relieve 
pain  and  prevent  discoloration.  To  be  accomplished  by:  Arnica  lo- 
tions, 275.  Aconite  lotions,  265.  Spirit  and  ammonia  lotions,  273. 
Poultices  of  black  bryony  root  (Bryonia  nigra),  used  by  pugilists. 
Glycerine.  Oil  of  turpentine.  Expressed  juice  of  leaves  of  Mikania 
Guaco.     Dilute  solution  of  subacetate  of  lead. 

BOILS. — A  boil  or  furunculus  (from  Ferveo,  to  burn)  is  a  circumscribed 
hard  tumor,  small  but  very  painful,  produced  by  inflammation  of  the 


BRASS-FOUNDER  S   AGUE — BRONCHITIS.  i9» 

true  skin  and  subjacent  areolar  tissue.     Morbid  process  terminates  in 
suppuration  and  ulceration. 

TreatmExNT.  Poultices.  Fomentations.  Painting  with  iodine.  Pe- 
ruvian balsam  ointment.  Incisions?  Jalap  and  senna,  150.  Sulphate 
of  manganese,  172.  Quinine,  879.  Mineral  acids  and  bark,  376.  Liquor 
arsenicaiis,  52.  Yeast.  Liquor  potassaj.  Tar,  36.  Nourishing  food. 
Wine  or  beer.     Change  of  air. 

BRASS-FOUNDER'S  AGUE.— A  peculiar  form  of  intermittent  fever, 
Avbicli  atfeets  brass-founders  and  other  workmen  exposed  to  the  fumes 
of  deflagrating  zinc.     Observed  in  the  Birmingham  foundries,  &c. 

Symptoms.  The  paroxysms  occur  irregularly.  Constriction  or  tight- 
ness about  chest.  In  the  evening,  shivering;  an  indistinct  hot  stage; 
profuse  sweating. 

Treatment.  Emetics  and  milk,  as  prophylactics.  Avoidance  of  the 
fumes  of  zinc.     Tonics,  quinine,  &c. 

BRIGHT'S  DISEASE.— A  term  indiscriminately  applied  to  all  renal 
diseases  accompanied  b}^  albuminuria  and  dropsy.  If  retained,  it  should 
be  limited  to  some  particular  form  of  kidney  disease.  There  may  be 
considerable  inconvenience,  however,  from  introducing  into  medical 
nomenclature  such  terms  as  Addison's,  Eright's,  and  Graves'  Disease. — 
See  Nephritis ;  Renal  Degenerations. 

BRONCHITIS. — From  Jipdyyoq,  the  windpipe;  terminal -ito.  Synon. 
Pulmonary  Catarrh. — Inflammation  of  mucous  membrane  of  bronchial 
tubes.  May  be  acute  or  chronic  ;  affects  one  or  both  lungs  throughout, 
or  only  a  portion  of  these  organs — usually  the  upper  lobes.  Symj)toms 
of  hay-asthma  often  of  a  bronchial  character. 

1.  Acute  Bronchitis. — A  dangerous  disorder:  inflammatory  action 
often  spreads  to  vesicular  texture  of  lungs. 

Symptoms.  Fever.  A  sense  of  tightness  or  constriction  about  chest. 
Hurried  respiration  with  wheezing.  Cough.  Expectoration  of  viscid 
glairy  mucus,  and  afterwards  of  purulent  secretion.  Frequent,  and 
often  weak,  pulse.  Foul  tongue.  Headache  and  lassitude.  Sickness. 
Great  anxiety. 

Inflammation  oi  larger  and  medium-sized  tubes,  attended  by  less  severe 
symptoms  and  results  than  general  and  capillary  bronchitis.  Latter,  rare 
in  adults;  chiefly  seen  in  very  young  and  old.  It  is  recognized  by 
tendency  to  cause  asphyxia;  paroxysms  of  dj^spnoea  or  orthopnoea; 
congestion  of  surface;  perpetual  cough;  general  restlessness;  increas- 
ing prostration  ;  and,  in  fatal  cases,  somnolence,  muttering  delirium,  and 
coma.  Sometimes,  during  progress  of  acute  bronchitis,  one  or  more 
tubes  become  choked  up  with  viscid  phlegm;  pulmonary  collapse  re- 
sulting— a  portion  of  lung  being  emptied  of  air.  One  frequent  result 
of  collapse  is  vesicular  emphysema ;  so  that  loss  of  function  in  airless 
part  of  lung  is  compensated  for  by  increase  of  volume  in  non-obstructed 
portion. 

In  early  stage  of  bronchitis,  auscultation  often  detects  two  dry 
sounds — rhonchus  and  sibilus.  Ehonchus  belongs  to  larger  bronchi : 
sibilus  bespeaks  more  danger,  as  denoting  that  smaller  air-tubes  and 
vesicles  are  affected.  After  inflamed  membrane  has  poured  out  fluid, 
the  dry  are  displaced  by  moist  sounds — large  and  small  crepitation. 
Ehonchus  and  large  crepitation  are  the  dry  and  moist  sounds  of  larger 
air-passages:  sibilus  and  small  crepitation,  of  the  smaller  branches. 
No  marked  alteration  in  resonance  of  chest  to  be  detected :  with  ex- 


52  BRONCHITIS. 

ception  of  increased  resonance  in  emphysema,  and  dull  percussion-note 
in  collapse. 

Treatment.  Confinement  to  bed.  Temperature  of  room  65°  to  70° 
F.  Air  to  be  moistened  by  steam.  Beef-tea;  milk  arrowroot  or  gruel; 
tea  with  milk;  soda  water  and  milk.  Mucilaginous  drinks,  19.  Sarsa- 
parilla,  squills,  and  barley  water,  238.     White-wine  whey,  10. 

If  there  be  constipation,  castor  oil ;  or  sulphate  of  magnesia  and  senna, 
139.  Saline  draughts,  348.  Ammonia  and  senega,  235.  Carbonate  of 
ammonia,  361.  Citrate  of  potash,  ammonia,  and  aconite,  211.  Dry 
cupping,  turpentine  stupes,  or  sinapisms  to  walls  of  chest.  Inhalation 
of  steam. 

Remedies  sometimes  advised :  Bleeding.  Blisters.  Friction  with  croton 
oil,  or  tartarated  antimony  ointment.  Emetics.  Tartarated  antimony. 
Calomel.  Colchicum.  Hydrocyanic  acid.  Chlorate  of  potash.  Laurel 
water.     Malt  (Byne).     Oxalic  acid.     Inhalation  of  chlorine. 

2.'  Chronic  Bronchitis. — Very  common  in  advanced  life. 

Symptoms.  Slighter  forms,  indicated  by  habitual  cough,  shortness  of 
breath,  copious  expectoration:  aggravated  by  exposure,  to  cold  and 
damp,  bad  living.  Cases  of  "  winter  cough"  in  old  people,  mostly  ex- 
amples of  bronchial  inflammation  of  a  low  lingering  form. — Impaired 
resonance  on  percussion,  especially  low  down  posteriorly:  on  ausculta- 
tion, feeble  vesicular  murmur,  mingled  with  rhonchus  and  sibilus  and 
moist  crepitation. — Dilatation  of  bronchi,  with  condensation  of  sur- 
rounding lung  tissue,  occasionally  results:  sometimes,  bronchorrhoea — 
excessive  and  fetid  muco-purulent  secretion. — Seldom  directly  fatal : 
may  be  indirect  cause  of  death  by  leading  to  other  diseases. 

Treatment.  Carbonate  of  ammonia,  361.  Citrate  of  ammonia,  362. 
Ammonia  and  senega,  235.  Ammoniac  mixture  and  opium,  237.  Squills, 
ammonia,  and  morphia,  239.  Ipecacuan  and  Indian  sarsaparilla,  241. 
Nitrous  ether,  ipecacuan,  and  conium,  244.  Squills  and  conium,  243. 
Stramonium  and  dulcamara,  245.  Sarsaparilla  and  squills,  238.  Squills, 
nitric  acid,  and  bark,  236.  Compound  squill  pill.  Benzoate  of  ammonia. 
Cod-liver  oil.     Wine.     Nourishing  food.     Milk. 

Locally  :  Inhalation  of  simple  vapor.  Turpentine  or  creasote  inhala- 
tions, 260.  Inhalation  of  atomized  fluids,  262.  Counter-irritation  to 
thoracic  walls  by  sinapisms ;  turpentine  stupes;  stimulating  liniments, 
277,  278.  Warm,  pitch,  galbanum,  or  chalybeate  plasters.  Respirator 
to  be  worn. 

Remedies  sometimes  recommended :  Emetics  of  antimonial  wine,  or  sul- 
phate of  zinc.  Tartarated  antimony.  Compound  tincture  of  benzoin. 
Copaiba.  Cubebs.  Creasote.  Guaiacum.  Digitalis.  Chlorate  of  pot- 
ash. Storax.  Suljjhur  and  acid  tartrate  of  potash.  Sumbul.  Nitrate 
of  silver  (locall}").  Balsam  of  Peru  (locally).  Blisters,  ointment  of  tar- 
tarated antimony,  or  croton  oil  (to  chest  walls). 

3.  Catarrhus  Senilis. — A  peculiar  and  severe  form  of  chronic  bn'on- 
chitis,  occurring  in  old  people.  Has  been  described  as  peripneumonia 
notha,  (bastard  peripneumony);  catarrhus  senilis ;  or  subacute  bronchitis. — 
Consists  of  a  subacute  attack  of  general  or  capillary  inflammation  of 
tubes.  Symptoms  of  violent  catarrh  :  more  or  less  dyspnoea  :  excessive 
secretion  of  opaque  frothy  mucus.  Often  much  relieved  by  remedies 
which  produce  copious  expectoration.  Sometimes  causes  fatal  prostra- 
tion :  or  patient  dies  from  suffocation,  unable  to  expel  accumulated 
mucus  :  or  deficient  oxygenation  of  blood  leads  to  coma. 

4.  Plastic  Bronchitis. — Eare  form  of  bronchial  disease.  Characterized 
by  formation  {UXuff/Tw,  to  form  or  figure,  to  make  an  image,  &c.)  of  solid 
or  tubular  concretions  of  exudation-matter  within  bronchi. 

Symptoms.     Expectoration  of  casts  of  tubes.     Small  fragments  ex- 


BRONCHITIS.  53 

polled  easily.  Expulsion  of  moulds  of  notable  size  preceded  by  dyspna'O  ; 
dry  cough  ;  haemoptysis.  Sometimes,  excessive  haemoptysis:  tibi-iiious 
concretions  detached,  but  not  easily  expelled  from  tubes.  Occasionally, 
aneurismal  or  some  other  form  of  hemorrhage;  casts  consisting  of  de- 
colorized coagulated  blood.  Cases  of  plastic  bronchitis  may  last  for 
years,  with  occasional  acute  seizures. 

Treatment.  Remedies  very  ineffectual.  Carbonate  of  ammonia, 
361,  371.  At  time  of  hemorrhage,  gallic  acid,  1U3 :  turpentine,  102: 
iron-alum,  116:   tannin  and  nitric  acid,  99.     Nourishing  food.     Sea  air. 

5.  Mechanical  Broncrdtis. — Due  to  inhalation  of  different  particles 
which  irritate  bronchi.  For  example,  grinder's  rot,  or  knife-grinder's 
disease;  carbonaceous  bronchitis,  or  black  phthisis,  occurring  in  miners, 
from  inhalation  of  lamp-smoke  and  carbonic  acid  gas  formed  in  pits; 
and  cotton  pneumonia,  or  cotton  phthisis,  met  with  amongst  operatives 
in  cotton  mills. — Larch  or  Venice  turpentine  (Terebinthina  laricea),  in 
doses  of  gr.  15 — 20  made  into  pills  with  liquorice  powder,  and  tal^en 
thrice  daily,  often  serviceable. 

6.  Secondary  Bronchitis. — Bronchitis  occurring  secondarily  in  blood- 
diseases,  often  troublesome.  Typhoid  bronchitis,  may  greatly  aggravate 
danger  in  enteric  fever.  —  Gouty ^  or  rheumatic  bronchitis,  will  require 
colchicum  and  iodide  of  potassium. — Syphilitic  bronchitis,  occurs  in  sys- 
tem poisoned  to  secondary  or  tertiary  degree.  Causes  excessive  muco- 
purulent expectoration;  night  sweats;  wasting;  great  debility.  May 
be  cured  by  iodide  of  potassium,  31.  Compound  pill  of  calomel.  Mer- 
curial vapor  bath,  131.  Iodine  inhalations,  259.  Atomized  iodine,  or 
corrosive  sublimate,  spra}"^,  262. 

7.  Hay-Asthma. — Synon.  Hay- Fever ;  Summer  Catarrh. — May  be  de- 
scribed as  a  severe  catarrh,  with  asthmatic  sj^mptoms  superadded. 
Probably  due  to  inhalation  of  aroma  of  spring  grass  and  hay. 

Symptoms.  Conjunctival,  nasal,  faucial,  and  bronchial  mucous  mem- 
branes are  each  affected.  Headache.  Suffusion  of  ej^es.  Sneezing. 
Irritation  of  nose  and  fauces.  Dry  harassing  cough.  Paroxysmal 
attacks  of  asthma. 

Treatment.  May  be  cut  short  by  removal  from  cause ;  residence  at 
sea-side  especially.  Susceptibility  sometimes  destroyed  by  quinine  and 
steel;  arsenic;  nux  vomica. 

During  attack:  Tincture  of  lobelia,  88.  Ammonia  and  assafoetida,  86. 
Valerian  and  assafoetida,  94.  Ether  and  opium  with  camphor,  85.  Bel- 
ladonna and  zinc,  410.  Stramonium.  Indian  hemp.  Coffee.  Subcu- 
taneous injections  of  atropine,  314.  Creasote  inhalations,  261.  Pipe 
of  tobacco. 

BRONCHOCELE.  —  From  Bpoyyoq,  the  windpipe;  zf;;.i;,  a  swelling. 
Synon.  Thyrocele ;  Wen  ;  Goitre  by  the  Swiss ;  and  in  this  country  Derby- 
shire  Neck  from  its  prevalence  in  some  parts  of  Derbyshire.  An  enlarge- 
ment of  the  thyroid  gland. 

Symptoms.  The  whole  gland  may  be  swollen,  or  only  the  centre,  or 
either  side — especially  the  right.  Sometimes  no  inconvenience  beyond 
the  deformity.  In  other  cases,  throbbing  of  vessels,  palpitation  of  heart, 
mental  depression,  dyspe])sia,  and  other  manifestations  of  attenuated 
blood.  Difficult  respiration  and  deglutition  from  pressure  of  tumor. 
Irregularity  of  uterine  functions.  Scanty  menstruation.  Profuse  leu- 
corrhoea. 

A  cystic  form,  in  which  cysts  are  developed  in  the  gland.  Their  lining 
membrane  very  vascular :  brown-colored  serous  contents. 

Exophthalmic  goitre.  Protrusion  of  eyeball  (proptosis  oculi);  strong^ 
pulsations  in  thyroid  body;  palpitation  of  heart,  with  a  bruit. 


54  BUBO — BURNS   AND    SCALDS. 

Treatment.  Eemoval  from  infected  loealit}^.  Eegular  establishment 
of  menstrual  functions.  Iodide  of  ammonium,  38.  Iodide  of  potassium, 
31.  Cod-liver  oil.  Iodide  of  iron,  32.  Quinine  and  iron,  380.  Bromide 
of  iron.  Steel  and  aloes,  393.  Digitalis.  Liquor  potassae.  Bromide  of 
potassium.  Strychnia.  Bromide  of  ammonium.  Nourishing  food.  Cold 
bathing.     Sea  air. 

Locally  :  Comj^ound  iodine  ointment  with  cod-liver  oil,  308.  Diluted 
iodine  liniment.  Ointment  of  iodide  of  ammonium.  Ointment  of  iodide 
of  potassium.  Ointment  of  red  iodide  of  mercury,  302.  Ice.  Setons. 
Ligature  of  thyroid  arteries.  Electro-puncture.  Injection  with  solu- 
tion of  perchloride  of  iron,  dangerous.  Extirpation  of  the  gland,  unjus- 
tifiable.    See  Graves'  Disease. 

BUBO. — From  Bvu,3a)v,  a  tumor  of  the  inguinal  glands.  Synon.  Aden- 
ophyma  Inguinalis.  Consists  either  of  a  simple  or  of  a  specilic  inflam- 
matory enlargement  of  a  lymphatic  vessel,  or  of  one  of  the  glands  in 
connection  with  such  vessel.  Term  "  bubo"  especially  applied  to  inflam- 
mation of  the  inguinal  glands.     Superficial  glands  alone  affected. 

There  are  several  varieties  : 

(1)  Simple  Sympathetic  Bubo. — Whatever  causes  lymphatic  irrita- 
tion may  give  rise  to  simple  inflammatory  adenitis.  Hence  it  may  arise 
from  balanitis,  gonorrhoea,  excessive  venery,  <fec.  The  action  may  end 
in  resolution,  or  go  on  to  suppuration. — Eequires  rest.  "Warm  bathing. 
Tonics.     Cod-liver  oil.    Evacuation  of  pus. — See  Adenitis. 

(2)  Primary  Bubo. — Said  to  form  from  the  direct  absorption  of  syphi- 
litic matter,  without  the  occurrence  of  any  chancre  or  sore.  Very  rare. 
Described  as  bubon  d'eniblee  by  the  French. 

(3)  Amygdaloid  Indolent  Bubo. — Comes  on  simultaneously  with 
induration  in  eases  of  infecting  chancre.  Suppuration  only  occurs  from 
some  accidental  complication.  Treatment  the  same  as  for  constitutional 
syphilis. 

(4)  Virulent  or  Inoculable  Bubo. — Due  to  absorption  of  virus  from 
a  soft  or  from  a  phagedenic  chancre.  Affected  gland  suppurates:  walls 
of  resulting  abscess  form  a  syphilitic  sore,  the  pus  from  which  is  inocu- 
lable.— Eequires  free  incisions.  Potassa  fusa.  Soothing  dressings.  Fre- 
qnent  syringing.     Quinine  and  iron.     Nourishing  food. 

BULIMIC  DYSPEPSIA. — Bou,  abbreviation  of /3oDc,  as  an  augmentative 
particle;  /lao?,  hunger. — (jou/t/^o?,  excessive  hunger:  zJyij,  difficult;  rtTrrw, 
to  digest. — In  some  cases  of  nervous  gastric  disturbance  the  appetite  is 
exaggerated  :  is  scarcely  appeased  by  food.  Digestion  takes  place 
easily  and  naturally;  or  is  accompanied  with  acid  eructations  and  p}-- 
rosis.     Stomach  often  dilated. 

Symptoms.  Desire  for  food  returns  immediately  after  a  meal.  Con- 
stant hunger.  Faintness  and  mental  depression.  Painful  sense  of 
sinking  about  praecordia. 

Treatment.     Cod-liver  oil,  389.    Eaw  minced  meat,  2.     Pepsine,  420. 

BURNS  AND  SCALDS. — Synon.  Ambustio  (Ainburo,  to  burn  around). 
The  danger  varies  according  to  the  extent  of  surface  injured,  the  de- 
gree of  tissue  disorganization,  the  importance  of  the  organ  implicated, 
and  the  age  and  constitution  of  patient. 

Symptoms.  Shock  to  S3^stem,  sometimes  so  severe  as  to  produce  fatal 
syncope.  Pallor  and  coldness  of  surface  and  extremities;  shiverings. 
liapidit}^  and  feebleness  of  pulse.  Imperfect  reaction  and  exhaustion; 
or  violent  reaction  with  fever,  and  congestion  or  inflammation  of  lungs, 
or  brain,  or  bowels:  or  hectic  fever  from  tedious  cicatrization,  exhaust- 


CiECITIS.  55 

ing  discliarges,  &c.  In  few  cases  can  the  danger  be  said  to  be  over  until 
after  the  hipse  of  nine  days.  Wliere  recovery  ensues,  there  is  the  fear 
of  deformity  from  contraction  of  cicatrices. 

Treatment.  To  bring  about  reaction  and  relieve  pain  administer  a 
full  (lose  of  opium,  with  mulled  ]>ort  wine  or  brandy  and  water:  repeat 
the  dose  if  necessar}'.  Chloroform  inhalation,  where  pain  is  excessive: 
the  injured  part  to  be  dressed  while  patient  is  insensible.  After  reaction 
is  well  established,  a  dose  of  castor  oil  or  a  purgative  enema  if  there  be 
constipation.  Simple  salines,  where  internal  organs  are  congested  or 
inflamed.  Ice.  Ammonia  and  bark,  port  wine  or  brandy,  milk  and 
raw  eggs,  beef  tea  with  pounded  meat,  cod-liver  oil,  where  there  is 
depression.  In  all  cases,  perseverance  with  opium  or  chloroform  to 
remove  pain  and  nervous  irritability. 

Locally :  Chief  object  to  prevent  access  of  air  to  injured  surface.  Im- 
mersion in  cold  Avater  for  many  hours  where  only  a  portion  of  a  limb  is 
burnt.  Free  application  of  lime  liniment  (Carron  oil)  on  cotton-wool. 
Cotton-wool  alone,  with  gentle  bandaging.  Dusting  with  flour,  rice 
flour,  prepared  chalk,  or  equal  ])arts  of  starch  and  carbonate  of  lead. 
Crusts  formed  by  the  applications  not  to  be  removed  until  loosened  by 
discharges.  Dressing  with  sulphur  ointment,  or  turpentine  ointment, 
subacetate  of  lead  ointment,  carbonate  of  zinc  in  ointment  or  powder, 
creasote,  glj'cerine,  sulphate  of  zinc  lotion,  solution  of  gum,  collodion, 
treacle,  &c. 

Patient  to  be  kept  in  an  easy  position,  between  blankets,  and  on  a 
water  bed  if  necessary.  All  vesicles  to  be  pricked,  so  that  tension  may 
be  relieved  by  escape  of  contents;  but  the  raised  cuticle  not  to  be  dis- 
placed. The  prevention  of  deformity  to  be  attempted  by  attention  to 
position,  by  movements  of  joints  where  practicable,  and  by  lubricating 
cicatrix  freely  with  oil. 

C^CITIS. — From  Caucus,  blind;  terminal  -itis.  Synon.  Typhlitis; 
Tup/ilo-enteritis. — Inflammation  of  the  caecum  or  its  appendix. — May  be 
due  to  accumulation  of  hard  fecal  matter,  skins  or  stones  of  fi-uit,  biliary 
and  intestinal  concretions,  balls  of  lumbrici  and  oxyurides,  &c. 

Symptoms.  In  aaite  form  :  Fever ;  nausea;  constipation.  Fulness 
and  tenderness  about  right  iliac  region  :  pain,  rendered  exquisite  by 
pressure.  Position  on  right  side  selected,  with  trunk  somewhat  bent, 
and  knees  drawn  up,  to  relax  painful  tissues.  If  peritoneal  coat  get 
involved,  appendix  becomes  inflamed  ;  followed  by  evidence  of  general 
peritonitis.  Areolar  tissue  round  caecum  may  also  become  inflamed 
(perityphlitis)  :  suppuration  and  abscess. 

When  inflammatoiy  action  begins  in  vermiform  appendix  from  consti- 
tutional causes,  or  escape  into  this  part  of  morbid  matter,  symptoms  are 
ver}^  acute.  Excruciating  tormina;  tj'mpanites;  hiccup;  violent  sick- 
ness. Obstruction  of  bowels.  Great  pain,  extending  to  right  ovarj-  or 
testicle,  and  shooting  down  inside  of  thigh.  Gangrene  and  general 
peritonitis  may  follow,  and  cause  death.  Or  a  portion  of  large  intestine 
and  caecum  with  appendix  may  slough  ofl:',  be  passed  with  stool,  and  yet 
recovery  ultimately  ensue.  In  tuberculous  typhlitis,  ulceration  occurs 
more  frequently  in  appendix  than  in  esecum  itself. 

In  chronic  csecitis:  S3'mptom8  come  on  slowly  and  insidiously.  Fail- 
ing health;  weakness;  loss  of  flesh.  Colicky  pains  in  right  iliac  region. 
Flatulence;  loss  of  appetite.  Diarrhoea  alternating  with  constipation. 
If  mucous  coat  ulcerates, — mucous  discharges;  attacks  of  hemorrhage. 
When  fatal,  exhaustion  generally  the  cause.     Perforation  rare. 

Treatment.  If  acute :  Opium.  Opium  and  belladonna.  344.  Olive 
oil  enemata,  188.     Mucilaginous  drinks,  19.     Chlorate  of  potash  drink. 


56  CANCER    OR    CARCINOMA. 

360.  Lemonade.  Ice:  iced  water.  Prolongedhot  hip  baths.  Fomen- 
tations. Linseed  poultices.  Most  perfect  quiet  in  bed.  Milk  diet. — If 
symptoms  of  suppuration  set  in  :  Ammonia  and  bark,  371.  Quinine  and 
ammonia,  386.  Brandy  and  egg  mixture,  with  opium,  318.  Milk  or 
cream.     Raw  eggs.     Essence  of  beef     Port  wine. 

Chronic  form. :  Mineral  acids  with  quinine,  379.  Iodide  of  ammonium 
and  bark,  38.  Cod-liver  oil.  Warm  bathing.  Application  of  belladonna, 
265.  Wet  compress  with  belladonna,  297.  Simple  nourishing  food.  Sea  air. 

CANCER  OR  CARCINOMA.— From  Kapxhoq,  a  crab.  In  the  present 
state  of  medical  science  a  cancer  may  be  described  as  a  local  manifesta- 
tion of  a  specific  disease  of  the  blood,  having  incorporated  in  it  peculiar 
morbid  materials  which  accumulate  in  the  blood,  and  which  its  growth 
may  tend  to  increase.  As  it  is  of  constitutional  origin,  so  the  removal 
of  the  local  manifestation  does  not  effect  a  cure;  but  the  cancer  returns 
either  in  the  seat  of  original  disease,  or  in  some  other  parts.  Moreover, 
when  the  primary  affection  has  existed  for  a  variable  period,  secondary 
deposits  are  very  apt  to  be  formed  in  the  lymphatic  glands,  lungs,  liver, 
spleen,  &c.  This  definition  does  not  meet  with  universal  acceptance; 
since  some  authorities  now  assert  that  the  disease  is  at  first  local,  though 
at  an  early  period  it  becomes  general. 

There  are  three  principal  varieties,  and  five  suhvarieties  of  malignant 
disease:  the  latter  probably  mere  modifications  of  the  former.  They 
consist  of: 

Scirrhus,  or  Hard  Cancer. 

Medullary,  or  Soft  Cancer. 

Epitlielial  Cancer. 

Colloid,  Gelatiniform,  Alveolar,  Cystic,  or  Gum  Cancer. 

Melanoid,  or  Black  Cancer. 

Osteoid  Cancer. 

Hsematoid  Cancer,  or  Fungus  Ilsematodes. 

Villous  Cancer. 

Symptoms.  A  separable  tumor,  or  an  infiltration;  which  alters  the 
original  texture  of  organ  in  which  it  is  seated,  invades  surrounding 
parts,  extends  to  lymphatics,  and  involves  system  generally".  Softening 
and  disintegration  of  the  growth.  Ulceration  of  skin  or  mucous  mem- 
brane. A  foul,  excavated,  spreading  ulcer.  Sanious,  foetid  discharges. 
Hemorrhages.  Pi'ogressive  debility  and  emaciation.  Nausea  and 
vomiting.     Diarrhoea.     Complete  prostration.     Exhaustion.     Death. 

The  cancerous  cachexia:  Dirty  yellow  hue  of  skin.  Contracted  fea- 
tures. General  wasting.  Loss  of  strength  and  energy.  Mental  irri- 
tability. 

Cancerous  growths  abound  in  cell-formations  and  bloodvessels. 
"  Cancer-cells"  have  one  or  more  nuclei  of  large  size,  and  one  or  two 
nucleoli.  They  bear  a  resemblance  to  secreting  gland-cells.  Degene- 
ration of  the  cells.  "  Cancer-juice," — a  viscid  or  creamy  fluid.  A  basis 
of  fibrous  tissue.  Microscopical  examination  of  tumors  an  aid  to  diag- 
nosis. 

Treatment.  General  indications :  Maintain  the  constitutional  powers 
by  tonics,  nourishing  food,  pure  air,  warm  clothing,  removal  of  offensive 
discharges,  and  mental  occupation  as  long  as  possible. 

Relief  of  Pain  :  Extract  of  opium,  343,  345.  Opium  with  belladonna, 
344.  Liquid  extract  of  opium.  Mor])hia,  315.  329,  343.  Conium,  336. 
Henbane.  Codeia.  Indian  hemp.  317, 337.  Ether.  Chloroform.  Ex- 
tract of  hop.  Subcutaneous  injectiotis  of  morphia,  314.  Aconite.  Atro- 
pine, 326.  Iodoform,  338.  Opiate  enemata,  339.  Opiate  suppositories, 
340. 


CANCRUM    ORIS — CARBUNCLE.  0< 

Trnprovement  of  the  Blood:  Liquid  extract  of  yellow  cinchona.  Bark 
and  ammonia,  371.  Bark  and  mineral  acids,  376.  Iodide  of  iron,  382, 
391).  Keduced  iron,  394.  Ammonio-citrate  of  iron,  401,  403.  Phosphate 
of  iron,  405.  Quinine  and  iron,  380.  Lemon-juice  and  chiretta,  377. 
Salicin,  388.  Sarsaparilla.  Sulphite  of  magnesia,  48.  Chlorate  of  pot- 
ash, 61.     Cod-liver  oil,  389.     Pepsine.  420. 

Animal  food.  Milk  and  cream.  Paw  eggs.  Brandy.  Wine.  Beer. 
Vichy  or  soda  water.     Wenham  Lake  ice. 

Abatement  of  local  growth  and  systemic  contamination  :  Belladonna  and 
opium,  344.     Quinine  and  belladonna,  383.     Zinc  and  belladonna,  332. 

Local  Remedies:  Belladonna,  265,  293.  Opium  and  belladonna,  297. 
Extract  of  poppies.  Extract  of  conium.  Iodoform.  Carbonic  acid  gas. 
Oxygen  gas.  Charcoal  poultice.  Yeast  poultice.  Hemlock  ])onltice. 
Chlorine  poultice.  Linseed  poultice,  with  or  without  belladonna  or 
opium  incorporated.  Carrot  poultice.  Logwood,  82.  Chlorate  of  potash 
lotion.  Iodide  of  potassium  lotion.  Citric  acid  lotion,  264.  Friction 
with  solutions  of  iodide  of  lead,  or  iodide  of  potassium,  or  bromide  of 
potassium.     Perchloride  of  iron.     Cotton-M^ool. 

Operative  Treatment :  Free  excision.  Union  by  first  intention  not 
desii-able.  Excision,  followed  immediately  by  sponging  entire  surface 
of  wound  with  solution  of  chloride  of  zinc  (grs.  50  to  fl.  oz.  j).  Excision 
followed  by  prolonged  administration  of  belladonna,  383,  410.  Ligature 
of  nutrient  arteries.  Electricity.  Methodical  compression.  Congela- 
tion.    Actual  cautery.     Galvanic  cautery.     Friction  and  palpation. 

Kemoval  by  caustics:  Chloride  of  zinc,  197.  Chloride  of  zinc  and 
puccoon.  Chloride  of  bromium,  196.  Dried  sulphate  of  zinc.  Super- 
sulphate  of  zinc,  198.  Arsenical  paste,  199.  Manganese  cum  potassa. 
Strong  mineral  acids.     Concentrated  alkalies.     Vienna  paste,  204. 

Remedies  often  tried  and  found  valueless  :  Calomel.  Corrosive  sublimate. 
Iodine.  Iodide  of  potassium.  Iodide  of  mercury.  Iodide  of  lead.  Bro- 
mine. Bromide  of  potassium.  Arsenic.  Iodide  of  arsenic.  Sanguinaria 
Canadensis,  or  puccoon.  Chloride  of  lime.  Hydrocyanic  acid. — Milk 
diet. — Leeches.     Venesection.     Blisters.     Syphilization. 

CANCRUM  ORIS.— Sloughing  phagedena  of  the  mouth.     Occurs  in 

young  children. — See  Stomatitis. 

CARBUNCLE.— Dimin.  of  Carbo,  "a  live  coal."  Synon.  Anthrax 
(from  "AvOpa^,  a  coal). — Consists  of  severe  inflammation  of  a  circum- 
scribed portion  of  skin  and  subjacent  tissue,  with  infiltration  of  un- 
healthy lymph. 

Symptoms.  Flattened  circular  swelling.  Throbbing  or  dull  aching 
pain.  Suppuration.  Bloody  purulent  discharge.  Slough  of  areolar  tissue. 
Vitiated  state  of  the  blood.  Constitutional  disturbance.  Prostration. 
Fear  of  pyemia. 

Treatment.  Poultices.  Anodyne  fomentations.  Opium  plaster. 
Crucial  incisions.  Subcutaneous  incisions.  Potassa  fusa,  rubbed  into 
the  centre  until  an  eschar  is  formed,  with  avoidance  of  incisions  and 
poultices.  Congelation.  Acid  nitrate  of  mercury.  Nitrate  of  silver. 
Turpentine  ointment.  Iodine,  205.  Warm  bathing  to  remove  the  dis- 
charges.    Cotton- wool. 

Podophyllin,  160.  Jalap  and  senna,  151.  Colocynth  and  blue  pill, 
172.  Saline  aperients  with  eolchicum,  152.  Castor  oil.  Chlorate  of  pot- 
ash and  steel,  4U2.  Arsenic,  52.  Tar  capsules,  36.  Mineral  acids  and 
bark,  376.  Ammonia  and  bark,  371.  Quinine,  379.  Opium.  Moi-phia 
and  Indian  hemp,  317.  Nourishing  food.  Hassall's  flour  of  meat.  Milk. 
Alcoholic  stimulants. 


58  CARDIAC    ANEURISM — CARDIAC    CANCER. 

CARDIAC  ANEURISM. — From  Kap8ia,  the  heart:  "A'^eupwaj,  to  dilate. 
— Two  forms  of  aneurism  of  the  heart:  (1)  The  acute  variety,  depends 
on  a  laceration  of  endocardium  and  muscular  tissue,  through  which  the 
blood  passes  and  makes  a  pouch.  In  this  pouch  fibrine  is  deposited, 
while  at  its  entrance  is  a  fringed  margin  of  endocardium  with  vegeta- 
tions attached.  (2)  The  chronic  form,  results  from  some  inflammatory 
condition  of  muscular  fibre,  or  of  endocardium.  Walls  of  sac  consist  of 
endocardial  and  pericardial  membranes  unbroken,  while  the  muscular 
fibre  seems  to  be  replaced  b}'  a  fibroid  tissue. — Either  kind  of  aneurism 
gives  rise  to  obscure  and  uncertain  sj'mptoms.  Passage  of  blood  into 
sac  may  cause  a  murmur.    Death  usually  occurs  suddenl}'  from  rupture. 

Aneurismai  dilatation  and  rupture  of  coronary  arteries  not  a  frequent 
event.     No  symptoms  during  life  to  allow  of  correct  diagnosis. 

CARDIAC  ATROPHY. — From  Kapdla,  the  heart:  'A,  priv  ;  Tpi<paj,  to 
'  nourish. — Two  foi'ms  :  (1)  That  in  which  the  heart  wastes  and  dwindles 
in  all  its  parts.     (2)  The  texture  of  the  muscular  walls  suffers  a  more 
or  less  complete  conversion  into  fat. 

1.  Simple  Atrophy. — Occurs  in  connection  with  many  exhausting  dis- 
eases,— cancer,  tuberculosis,  diabetes,  &c. — The  whole  heart  diminishes  in 
size:  after  death  weight  found  reduced  from  9  to  5  oz.  Minute  exam- 
ination detects  the  muscular  fibres  pale  and  soft,  but  otherwise  health3^ 
The  treatment  must  be  that  demanded  by  the  constitutional  state,  of 
which  the  atrophy  is  merely  a  symptom. 

2-  Fatty  Degeneration  of  Heart. — Occurs  alone;  or  in  conjunction 
with  fatty  disease  of  liver,  kidneys,  cornea,  &c.  Yalvular  disease 
rarely  coexists;  when  it  does,  aortic  more  generally  affected  than 
mitral  valves. 

Symptoms.  Feeble  action  of  heart :  slow  pulse,  sometimes  as  low  as 
fifty  or  forty-five.  General  debility.  Transient  attacks  of  giddiness  or 
faintness.  Nervous  exhaustion,  and  loss  of  tone.  Heart's  sounds  weak. 
Attacks  of  dyspnoea.  Many  of  the  symptoms  of  angina  pectoris.  Per- 
haps, an  areas  senilis. — Occurs  more  frequently  in  men  than  women. 
Most  common  at  advanced  period  of  life.  May  cause  sudden  death, — 
perhaps  from  rujiture. 

Treatment.  Nourishing  animal  food.  Milk.  Cream.  Cod-liver  oil. 
Mineral  acids.  Mild  preparations  of  steel.  Attention  to  digestive  organs. 
Eesidence  in  pui-e  air.  Early  hours.  Gentle  exercise.  Avoidance  of 
excitement.     Tepid  salt-water  sponge  baths. 

3.  Fatty  Growth. — That  condition  in  which  the  fat  normally  depos- 
ited upon  the  heart  is  increased  on  and  amongst  the  muscular  fibres  to 
a  morbid  extent.  May  occur  alone;  or  in  conjunction  with  general 
obesity;  or  in  association  with  fatty  degeneration. 

Symptoms.  When  existing  alone  the  chief  features  are  those  of  a 
heart  enlarged  and  impeded  in  the  performance  of  its  functions.  Pulse 
permanently  quickened  above  normal  standard,  while  its  force  is  di- 
minished. 

Treatment.  Animal  food.  Light  French,  German,  or  Hungarian 
wines.  Avoidance  of  sugar,  vegetables,  oily,  and  starchy  substances. — 
See  Obesity. 

CARDIAC  CANCER. — From  Kapdia,  the  heart. — Primary  cancer  of 
heart  exti'omely  rare.  This  organ  is  secondai-ily  involved  more  fre- 
quently. Pight  auricle  most  frequent  seat:  sometimes  perforated  by 
the  malignant  growth.  Disease  occasionally  extends  along  coats  of 
large  veins.  It  may  occur  as  an  infiltration  in  muscular  tissue,  or  as  a 
deposit  in  form  of  tumor. 


CARDIAC    DILATATION CARDIAC    HYPERTROPHY.  59 

Cancer  of  pericardium  almost  invariably  tlio  result  of  secondary  and 
general  dejiosits.     Medullary  more  common  than  scirrhus. 

CARDIAC  DILATATION.— May  occur  under  three  forms  :  (1)  Hyper- 
trophy of  heart  with  dilatation:  known  as  active  dilatation,  when  the 
expansion  predominates  over  the  hypertrophy.  (2)  Simple  dilatation, 
wiiere  thickness  of  walls  is  normal.  (3)  Passive  ov  attenuated  dilatation, 
the  walls  being  thinned.  Often  combined  with  malnutrition  of  heart, 
and  fatty  degeneration  of  muscular  fibi"es.  May  arise  fi"om  exhausting 
disease,  endocarditis,  or  perhaps  from  pericardial  adhesion.  The  chief 
symptoms  are,  a  small  weak  pulse;  coldness  of  extremities;  giddiness, 
and  deranged  digestion.  Attacks  of  fainting;  paroxysms  of  asthma; 
restless  nights;  palpitation;  perhaps,  anasarca  followed  by  ascites. 
Antispasmodics,  ferruginous  tonics,  and  agents  to  aid  digestion  are  the 
only  remedies.  Alum  has  been  recommended.  Digitalis  may  deserve 
a  cautious  trial. 

CARDIAC  FUNCTIONAL  DERANGEMENT.— From  KapSh,  the  heart. 
May  closely  simulate  oi'gaiiic  disease  of  heart.  Occurs  in  cases  of 
hysteria,  ovarian  or  uterine  irritation,  neuralgia,  anaemia;  not  uncom- 
mon in  women  at  "change  of  life."  May  be  due  to  nervous  exhaustion 
from  over-study,  anxiety,  sexual  excesses,  &c. ;  to  gout,  rheumatism,  or 
chronic  liver  disease;  to  use  of  tobacco  or  strong  tea;  to  dyspepsia. 

Symptoms. — There  may  be  irregular  pulse,  palpitation,  iluttering; 
with  a  cardiac  murmur  and  subcutaneous  oedema  in  anaemic  subjects. 
Dull  wearj'ing  ache  in  prgecordial  region  :  occasionally,  lancinating 
pains.  Inability  to  lie  on  left  side,  owing  to  tenderness.  Mental  de- 
pression. D3spepsia;  flatulence  and  acid  eructations.  Globus  hA'Ste- 
ricus.  Occasional  attacks  of  giddiness,  faintness.  headache,  noises  in 
ears,  flushings  of  face,  violent  pulsations  in  aorta,  &c. 

Treatment.  Allay  symptoms  while  removing  their  source.  Explain 
cause  of  suffering  to  patient.  Antispasmodics  and  sedatives  to  quiet 
circulation, — Ether  and  ammonia,  &c.,  85.  Assafoetida  and  ammonia, 
86.  Sumbul  and  ether,  95.  Henbane,  camphor,  and  hop,  325.  Codeia 
and  assafoetida,  328. — Where  there  is  any  connection  with  rheumatism, 
— Aconite  and  guaiacum,  330.  Potash  and  ammonia,  67. — In  gouty 
subjects, — Potash  and  aloes,  71.  Citrate  of  lithia,  64.  Stramonium, 
colchicum,  and  digitalis,  94.  Colchicum,  46,351,352.  Saline  draughts, 
348. — If  there  be  constipation  with  unhealthy  secretions, — Aloes  and 
jalap,  145.  Rhubarb  and  gentian,  146.  Phosphate  of  soda  and  aloes, 
149.  Pepsine  and  aloes,  155. — If  there  be  dyspepsia, — Carbonate  of 
magnesia,  62.  Ammonia  and  chiretta,  63.  Potash  and  ammonia,  67. 
Soda,  morphia,  and  hvdrocyanic  acid,  7U.  Animonia  in  eftervescence, 
362.  Bismuth,  65.  Nitro-hydrochloric  acid,  378.  Pepsine,  420.— If 
there  be  nervous  exhaustion  or  anajmia, — Citrate  of  steel  and  ammonia. 
401,  403.  Reduced  iron  and  pepsine,  394.  Phosphate  of  iron,  405.  Steel 
and  aloes,  404.     Quinine  and  iron,  380. 

In  all  forms, — Attention  to  diet.  Tobacco  and  tea  to  be  forbidden. 
Malt  liquors  usually  disagree.  Brandj^  and  soda  water.  Light  French, 
German,  or  Hungarian  wines.     Exercise  in  pure  air.     Sea  bathing. 

CARDIAC  HYPERTROPHY.— From  KapSia,  the  heart:  'Trzsp,  in  ex- 
cess; rpicfio,  to  nourish.  Synon.  Hypertrophia  Cordis. — The  heart  is 
I'oughiy  said  to  be  about  the  same  size  as  the  closed  fist.  Its  average 
weight  in  adult  male  is  9i  oz. :  in  female  82-.  After  sixtieth  year,  the 
weight  is  somewdiat  greater,  owing  to  the  thickness  of  walls  of  left 
ventricle  bavin ff  increased. 


60  CARDIAC    RUPTUllE CARDIAC    VALVULAR    DISEASE. 

The  muscular  walls  of  one  or  more  cavities  may  become  thickened 
without  any  diminution  in  size  of  chamber, —  simple,  hypertrophy.  Or, 
the  walls  ma}'  be  thickened,  and  the  chamber  enlarged, — eccentric  hyper- 
trophy, or  hypertrophy  with  dilatation.  Or,  the  increase  in  thickness  may 
be  accompanied  with  diminution  of  size  of  cavity, — concentric  hyper- 
trophy. Hypertrophy  often  beneficial :  it  counterbalances  some  impedi- 
7nent  to  flow  of  blood  through  heart,  or  to  free  play  of  this  organ. 
Hypertrophy'  of  left  ventricle  with  valvular  disease,  the  most  common 
form  of  this  affection.  Simple  hypei-trophy  of  left  ventricle  without 
any  obstruction  to  flow  of  blood  is  rare :  sometimes  found  in  cases  of 
chronic  Bright's  disease.  Hypertrophy  with  dilatation  of  right  ven- 
tricle, generally  due  to  some  chronic  disease  of  lungs  obstructing  cir- 
culation. 

Symptoms.  Will  depend  on  extent  of  hypertrophy.  Frequently, 
there  are  palpitations;  dj'spnoea;  difficult}^  in  walking  quickly  ]  unea- 
siness and  pain  about  cardiac  region  ;  headache  ;  repeated  attacks  of 
vertigo.  Systolic  sound  heard  less  distinctly  than  in  health.  Extent 
of  pulsation  and  degree  of  impulse,  increased.  Murmurs  in  valvular 
disease. 

Treatment.  Circulation  to  be  jvcpt  tranquil.  If  there  be  much  de- 
bility,— Quinine  and  steel,  380.  Steel  and  pepsine,  394.  Steel  and  am- 
monia, 401.  Phosphate  of  iron,  405.  Bark  and  ammonia,  371.  Mineral 
acids  and  bark,  376.  Nitro-hydrochloric  acid  and  chiretta,  378. — If 
heart's  impulse  be  verj'  great, — Aconite,  330.  Digitalis,  334. — When 
dyspnoea  is  urgent, — Ammonia  and  ether,  364.  Indian  hemp,  aconite, 
and  ether,  342.     Lobelia  and  ether,  322. 

Remedies  sometimes  employed:  Bromide  of  potassium.  Iodide  of  potas- 
sium. Hydrocyanic  acid.  Calomel.  Acid  tartrate  of  potash.  Acetate 
of  lead.  Henbane.  Morphia.  Digitaline.  Camphor.  Spirit  of  nitrous 
ether.     Hydrosulphuret  of  ammonia.     Blisters. 

CARDIAC  RUPTURE. —  From  KapSia,  the  heart.— Eupture  of  the 
heart  may  occur  spontaneously  from  previous  disease,  or  may  be  caused 
by  external  violence.  In  former  case,  more  frequent  on  left  than  right 
side;  in  latter,  the  reverse.  Laceration  of  walls  of  ventricles  most 
common.  Eupture  of  valves  or  their  tendons,  generally  the  consequence 
of  prior  attack  of  endocarditis:  laceration  of  muscular  wall  frequently 
symptomatic  of  fatty  degeneration,  or  of  rupture  of  aneurism  in  ven- 
tricular wall. 

When  death  does  not  result  immediately,  there  is  great  orthopnoea; 
intense  prostration  ;  syncope  ;  convulsions.  In  laceration  of  valves,  of 
chordae  tendinete,  or  of  musculi  papillares, — great  oppression  about  prae- 
cordia,  with  a  loud  endocardial  bruit.  If  wound  gets  plugged  with 
coagula,  patient  may  live  for  even  some  days. 

CARDIAC  VALVULAR  DISEASE.— From  Kap8ia,  the  heart.  Most 
of  the  alterations  in  internal  lining  membrane  of  heart  result  from  in- 
flammation, which  gives  rise  to  a  deposit  of  Ij-mph  upon  or  beneath  the 
serous  membrane.  The  valves  lose  their  delicacy  and  trans))arency  : 
become  thick,  puckered  and  adherent  to  each  otlier.  Independently  of 
inflammation,  the  valves  get  covered  with  warty  vegetations  or  ex- 
crescences; they  may  be  converted  into  bone;  or  they  become  the  seat 
of  atheromatous  or  other  deposits. 

Effects  twofold  :  Either  to  contract  and  narrow  the  orifice  and  so 
obstruct  the  passage  of  the  blood — valvular  obstruction ;  or  by  thickening 
and  shortening  the  valves,  to  make  the  orifice  more  or  less  patent,  and 
hence  permit  of  regurgitation  of  blood — valvular  insufficiency,  rcgurgi- 


CARDIAC    VALVULAR    DISEASE.  61 

tani  disease  of  valves,  &c.     There  may  be  only  valvular  obstruction,  or 
valvular  insufficiency;  often  these  conditions  coexist. 

Symptoms.  Difficulty  of  breathing,  varying  from  slightest  dyspnoea 
to  most  severe  orthopnoea:  increased  by  exertion.  Palpitation  and 
irregular  action  of  heart,  with  sounds  and  murmurs  discoverable  by 
auscultation.  Alterations  in  pulse:  soft  and  irregular  in  mitral  disease, 
hard  and  jerking  but  regular  in  aortic.  Congestion  of  lungs  ;  bronchitis  ; 
pneumonia;  pulmonary  liemorrhage.  Hemorrhages  from  nose,  bronchi, 
or  stomach.  Oedema  of  lower  extremities,  sometimes  of  arms  and  face  ; 
hydrothorax  ;  ascites.  Dropsy  more  common  in  affections  of  right  than 
of  left  cavities.  Headache,  noises  in  ears,  vertigo,  syncope,  cerebral 
congestion,  and  cerebral  hemorrhage  :  most  urgent  in  aortic  disease. 
Broken  rest,  startings  during  sleep,  frightful  dreams.  Enlargement  of 
liver  and  spleen.  Disordered  digestion.  A  peculiar  appearance  of  coun- 
tenance,— face  puffed ;  cheeks  flushed  and  of  purple  hue ;  lips  congested  ; 
eyes  bi'ight. 

As  disease  becomes  aggravated,  patient  gets  weak  and  very  nervous. 
Suffers  immediately  from  over-exertion,  mentalemotion,  improper  food, 
exposure  to  cold  and  wet.  Subsequently,  death  :  either  suddenl}-  from 
syncope,  or  gradually  from  progress  of  secondary  affections. 

Physical  signs :  Either  or  both  sounds  of  heart  accompanied  or  sup- 
planted by  a  bellows-murmur  (bruit  de  soufflet).  A  murmur  may  be 
harsh,  or  rough,  or  cooing,  or  whistling,  or  musical, — modifications  of 
but  slight  importance.  Of  whatever  character,  a  murmur  is  caused 
either  "by  obstructions  to  free  flow  of  blood  through  heart  and  great 
vessels,  producing  an  organic  murmur;  or  by  an  altered  state  of  blood, 
or  a  clot  in  one  of  heart's  cavities,  giving  rise  to  an  inorganic,  or  func- 
tional, or  hceinic  murmur. 

Lining  membrane,  valves,  and  orifices  of  left  side  of  heart  much  more 
frequently  diseased  than  those  of  right:  almost  questionable  whether 
disease  of  tricuspid  or  pulmonary  valves  can  be  positively  diagnosed. — 
Signs  of  disease  of  aortic  and  mitral  valves  may  be  thus  briefly  tabulated 
(Dr.  Harvey)  : 

Bruit  :  If  systolic,  and  loudest  at 

Base^KoKTic  obstruction. 

^pex^MiTRAL  insufficiency. 
Bruit  :  If  diastolic,  and  loudest  at 

Base=:AoRTiG  insufficiency. 

Apex=M.iTRAL  obstruction. 
Pulse  :  If  regular. 

Full,  or  strong.  [-=Aortic  disease. 

Jerking,  resilient. 
Pulse  :  If  irregular, 

Intermittent,  unequal,    ^  ^Mitral  disease. 

Soft,  small,  weak,  ) 

Semilunar  valves  of  pulmonary  artery  may  be  supposed  to  be  diseased 
when  the  bellows-murmur  can  be  traced  from  middle  of  left  edge  of 
sternum  up  towards  left  clavicle;  and  when  this  murmur  cannot  be 
heard  in  subclavian  or  carotid  arteries.  Pulse  remaining  unaltered. — 
Tricuspid  valve,  guarding  right  aurieulo-ventricular  opening,  seldom 
found  otherwise  than  healthy.  When  diseased,  a  murmur  may  be  heard 
over  central  and  lower  part  of  sternum,  extending  downwards  to  epi- 
gastrium, and  inaudible  in  aorta  and  its  branches.  There  is  also  tur- 
gescence,  with  pulsation  of  jugular  veins  at  every  ventricular  systole. 
Arterial  pulse  unaffected. 

To  determine  systolic  or  diastolic  character  of  a  mui'mur,  pulse  at 


62  CARDIALGIA — CATALEPSY, 

wrist  should  be  carefully  noted  during  auscultation :  if  systolic,  the 
bruit  must  be  synchronous  with  pulse,  and  if  most  audible  at  apex,  is 
indicative  of  mitral  disease ;  if  diastolic,  not  synchronous  with  pulse, 
and  most  audible  over  centre  of  sternum  and  along  course  of  aorta,  it 
denotes  aortic  disease. 

Treatment.  Three  indications  to  be  followed  :  (1)  To  abate  inordi- 
nate action  by  cautious  use  of  sedatives.  Digitalis.  H^'drocyanic  acid. 
Aconite.  Belladonna.  Conium.  Henbane.  Hop.  Opium,  or  morphia. 
(2)  To  ward  off  or  relieve  results  of  cardiac  disease,  as  pulmonary 
congestion,  pneumonia,  hemoi'rhage,  congestions  of  liver  and  kidneys, 
dropsy,  &c.  A  nutritious  diet.  Saline  purgatives,  Sulphate  of  soda, 
144.  Cream  of  tartar  and  buchu,  222.  Cream  of  tartar  and  taraxa- 
cum, 228.  Diuretics.  Squills  and  digitalis,  219,  224.  Potash  and  digi- 
talis, 220.  Urea,  225.  Elaterium,  157.  Resin  of  podophyllum,  160. 
Gamboge  and  blue  pill,  174.  Digitalis  and  calomel,  230.  Small  punc- 
tures at  various  parts  of  anasarcous  legs.  (3)  To  impart  strength  and 
tone  to  heart.  Nourishing  food.  French,  German,  or  Hungarian  wines. 
Warm  clothing.  Cod-liver  oil.  Ferruginous  tonics, — Quinine  and  steel, 
380.  Steel  and  glycerine,  392.  Steel  and  pepsine.  394.  Saccharated  car- 
bonate of  iron,  396.  Steel  and  ammonia,  401.  Phosphate  of  iron,  4(J5. 
Tepid  salt-water  sponge  baths,  127. 

CARSIALGIA. — From  Kap<iia,  the  heart;  (iXyo-:,  pain.  Synon.  Heart- 
burn.— The  uneasiness  is  popularly  believed  to  be  around  the  heart. — See 
Gastralgia. 

CAKIES. — From  Caries,  rottenness.  Synon.  Ulceration  of  Bone. — A 
disease  of  bone,  characterized  by  an  unhealthy  inflammation,  softening, 
and  molecular  disintegration  ;  accompanied  by  suppuration  of  surround- 
ing soft  tissues.  Most  frequently  attacks  the  vertebrae,  short  bones,  or 
cancellated  extremities  of  long  bones  (as  tibia).  Frequently  due  to 
scrofula,  syphilis,  abuse  of  mercury.  When  caused  by  syphilitic  taint, 
or  by  combinations  of  syphilis  with  abuse  of  mercury,  cranial  bones 
often  affected. 

Symptoms.  Commonly'  obscure  at  first ;  apt  to  be  attributed  to  rheu- 
matism. Deep-seated  pain.  Redness  and  swelling  of  tissues  over  af- 
fected part.  Abscess,  which  on  bursting  discharges  a  fetid  sanious  pus 
loaded  with  bony  granules.  On  introducing  a  probe,  it  easily  passes  to 
the  bone  and  sinks  into  it.  Fistulous  openings.  Constitutional  dis- 
turbance. 

Treatment.  Eradication  of  constitutional  disorder.  Tonics;  nour- 
ishing food;  cod-liver  oil;  sea  air.  Iodide  of  potassium  and  bark,  31. 
Iodide  of  iron,  32.  Chemical  food,  405.  Locally:  Great  cleanliness. 
Astringent  lotions  and  injections.  Other  remedies  failing,  removal  of 
diseased  portion  of  bone.  Escharotics  (potassa  fusa,  chloi'ide  of  zinc), 
where  use  of  knife  is  contraindicated. 

CATALEPSY. — From  A'araAa/z/Scfyw,  to  restrain,  or  hold  firmly.  Synon. 
Hysteria  ('ataleptica. — A  sudden  suppression  of  consciousness  and  voli- 
tion ;  patient  remaining  during  attack  in  same  position  in  which  she 
happens  to  be  at  commencement,  or  in  which  she  may  be  placed  during 
its  continuance.  Seizure  may  last  a  few  minutes,  several  hours,  or  one 
or  two  days.  Recovery  occurs  suddenly,  as  from  a  deep  sleep,  without 
recollection  of  what  has  occurred.  Nervous  and  hysterical  women 
suffer  from  these  attacks  more  frequently  than  other  persons.  Danger 
absent;  very  rarely  the  disease  ends  in  apoplexj^  or  insanity,  possibly 
when  connected  with  chronic  softening  or  with  tumor  of  brain. 


CATARACT CATARRH.  63 

Absence  of  mind  a  slight  form  of  catalepsy.     True    mesmerism    an- 
other variety.     The  disease  has  sometimes  been  endemic. 
For  treatment  see  Hysteria. 

CATARACT. — From  KarappdfTfruj,  to  confound  ;  because  the  sense  of 
vision  is  confounded  or  obscured,  if  not  destroyed  (Mayne). — Consists 
of  an  opacity  of  the  crystalline  lens,  or  of  its  capsule,  or  of  both ;  the 
effect  being  to  intercept  the  rays  of  light  on  their  way  to  the  retina. 
Three  forms  usuall}^  recognized,  according  to  situation  of  opacity,  viz., 
lenticular,  capsular,  and  capsulo-lenticular. 

Symptoms.  Hard  or  lenticular  cataract  of  old  people,  the  most  com- 
mon form.  Met  with  in  men  and  women,  between  fifty  and  seventy 
years  of  age.  Causes  objects  to  appear  as  if  obscured  by  a  thick  cloud 
or  gauze  :  allows  vision  to  be  most  clear  when  ])upil  is  dilated,  as  by  use 
of  atropine  or  belladonna,  or  by  light  being  dull  and  subdued.  In  ad- 
vanced cases  vision  reduced  simply  to  perception  of  light  from  dark- 
ness. Commonly  one  eye  first  affected,  and  then  the  other.  Move- 
mejits  of  iris  natural :  when  pupil  is  dilated  by  belladonna,  cataractous 
opacity  can  be  distinctly  seen  with  a  convex  glass  of  about  one  inch 
focus.  In  commencing  cataract,  lenticular  opacities  not  otherwise  per- 
ceptible may  be  seen  with  the  ophthalmoscope  as  opaque  stria»,  occupy- 
ing either  the  anterior  or  posterior  segment  of  the  lens,  and  springing 
from  the  centre  of  the  crystalline,  or  converging  towards  tiie  centre 
from  the  circumference  (Ernest  Hart). 

Soft  or  lenticular  cataract  of  young  people,  may  occur  at  any  time  of 
life.  Congenital  cataract  of  this  kind.  Due  to  disintegration  of  whole 
substance  of  lens,  which  becomes  opaque  and  swollen.  Symptoms 
much  the  same  as  of  hard  kind,  except  perhaps  that  vision  is  more  im- 
perfect. There  ajjpears  to  be  some  connection  between  diabetes  and 
soft  cataract. 

Capsular  cataract  may  result  from  chronic  inflammation.  Opacity  of 
a  dead  white  color;  commonly  affects  part  or  whole  of  anterior  wall 
of  capsule,  or  it  may  perhaps  be  confined  to  posterior  portion. 

Opacity  of  capsule  always  leads  to  opacity  of  lens,  so  that  capsulo- 
lenticular  cataract  is  common. 

Treatment.  One  of  three  operations:  (1)  Depression,  displacement^ 
or  '■'•couching  "  a  clumsy  and  generally  inefficient  proceeding  by  which 
the  lens  is  pushed  from  its  natural  j^osition,  so  as  to  allow  rays  of  light 
to  pass  through  pupil  to  retina.  (2)  Solution,  or  absorption,  in  which 
the  body  of  lens  is  broken  up,  at  several  sittings,  so  that  it  may  un- 
dergo absorption.  Only  suitable  for  soft  cataract.  (3)  Extraction,  in 
which  opaque  lens  is  removed  entire  through  an  incision  in  the  cornea. 

CATARRH. — From  Ka-zappiu>,  to  flow  down  little  by  little.  Inflamma- 
tion of  mucous  membrane  of  some  portion  of  air-passages.  Known  as 
coryza,  if  it  affect  Schneiderian  membrane  of  nose;  gravedo,  if  frontal 
sinuses  suffer;  bronchitis,  when  stress  of  disease  falls  on  trachea  and 
bronchial  tubes. — Catarrh,  as  affecting  mucous  lining  of  nose  and  throat, 
one  of  the  commonest  of  diseases. 

Symptoms.  Lassitude ;  pains  in  limbs ;  aching  of  back ;  sense  of  tight- 
ness across  forehead;  excessive  discharge  from  nostrils;  profuse  lachry- 
mation ;  hoarseness;  sore  throat;  furred  tongue;  more  or  less  feverish- 
ness;  thirst;  loss  of  appetite;  quick  pulse.  An  eruption  of  herpes  ap- 
pears upon  lips;  most  frequently  about  angles  or  middle  of  lower  lip. — • 
At  end  of  some  forty-eight  hours  sj'mptoms  begin  to  subside;  or  disease 
passes  into  a  more  severe  affection, — acute  tonsillitis,  bronchitis,  pneu- 
monia, &c. 


C-t  CELLULITIS    VENENATA CEREBRAL    HEMORRHAGE. 

Treatment.  Warm  bath.  Foot  bath.  Turkish  bath.  Powder  of 
ipecacuan  and  opium.  Warm  clothing.  An  extra  glass  or  two  of  wine. 
White-wine  whey  at  bedtime. 

CELLULITIS  VENENATA.— From  Cellula,  a  little  cell ;  terminal  -itis: 
Venenum,  poison  or  venom.  Sj-non.  Diffuse  Cellular  Inflammation. — Dif- 
fused inflammation  of  the  areolar  tissue ;  arising  from  one  or  more  punc- 
tures received  in  dissecting  the  dead  bod}',  or  from  bites  of  venomous 
reptiles,  &c.  May  occur  without  se))tic  inoculation  in  unhealthy  states 
of  system,  from  breathing  vitiated  air,  &c. 

Symptoms.  Erysipelatous  inflammation  of  areolar  tissue  and  absorb- 
ents. Skin  secondarily  involved.  Redness  and  tenderness  of  lympha- 
tics. Elgors.  Pain.  Offensive  perspiration.  Suppuration.  Gangrene. 
Delirium.     Jaundice.     Dyspnoea.     Stupor.     Fatal  exhaustion. 

Treatment.  Withdrawal  of  poison  by  suction  or  cupping  glass.  Lig- 
ature between  wounded  part  and  trunk.  Caustic.  Bark,  371,  376. 
Quinine,  379,  386.  Sulphite  of  magnesia,  48.  Chlorate  of  potash,  61. 
Tincture  of  perchloride  of  iron  and  glycerine,  392.  Brandy  and  egg 
mixture,  17.  Fomentations.  Poultices.  Incisions.  Leeches? — See 
Ichorhcemia. 

CEPHALALGIA.— From  KtfaXij,  the  head  ;  a'A^^c,  pain.  Synon.  CephaU 
odijnia ;  Dolor  Capitis. — See  Headache. 

CEPHALOHiEMATOMA.— From  Ks(pa?.rj,  the  head;  al/mroj/m,  a  san- 
guineous tumor.  Synon.  Cephalcematoma ;  Ecchymoma  Capitis  Hecens 
Natorum ;  Thrombus  Neonatorum. — A  bloody  tumor,  developed  immedi- 
ately after  birth,  betAveen  bones  of  skull  and  pericranium.  It  is  proba- 
bly caused  by  long-continued  pressure  upon  foetal  head  during  a  difficult 
labor. 

Symptoms.  Tumor  varies  in  size  from  that  of  a  hen's  egg  to  that  of 
a  large  orange.  Is  generally  formed  on  one  or  other  of  parietal  bones: 
on  right  more  frequently  than  left;  and  occasionally  on  both — double 
cephalohaematoma.  Swelling  soft,  circumscribed,  and  fluctuating:  its 
base  often  becomes  encircled  by  a  hard  ring,  probably  caused  by  occur- 
rence of  ossification  in  the  plasma  exudation  which  is  poured  out  by 
irritated  pericranium. 

Treatment.  Generally  best  to  leave  the  case  alone :  effusion  becomes 
absorbed  in  course  of  two  or  three  weeks.  In  some  instances,  absorp- 
tion may  be  hastened  by  use  of  evaporating  lotions.  Avoid  the  prac- 
tice sometimes  recommended  of  incising  tumor,  removing  blood,  and 
applying  compression.  Should  suppuration  take  place,  the  pus  must  be 
evacuated,  and  case  treated  as  a  dangerous  abscess. 

A  kind  of  false  cephalohsematoma  sometimes  produced  by  effusion  of 
blood  into  areolar  tissue  between  aponeurosis  of  scalp  and  pericranium. 
It  requires  no  treatment. 

CEREBRAL  HEMORRHAGE.— From  Cerebrum,  the  brain:  A'ljia, 
blood;  fjiyvoiii,  to  break  out. — Not  synonymous  with  apoplexy.  There 
may  be  symptoms  of  latter,  but  not  necessarily.  Pathognomonic  fea- 
ture, more  or  les^  paral^^sis  on  side  of  body  opposite  to  that  on  M'hich 
clot  is  formed.  Intellect  and  senses  may  be  unaffected.  Patient  may 
fall  down;  but  this  results  from  the  paralysis,  not  from  the  sudden  abo- 
lition of  consciousness  and  sensibilitj^  as  in  apoplexy.  In  same  way 
there  may  be  sudden  loss  of  power  in  arm,  or  speech  may  be  affected, 
but  without  loss  of  consciousness.  If  hemorrhage  continue,  then  S3'mp- 
toms  may  graduall}' merge  into  complete  apoplectic  condition  in  course 


CEREBRAL    INFLAMMATION.  65 

of  a  few  minutes  or  several  hours.  Many  eases  of  cerebral  licmorrliage 
recover,  provided  recourse  bo  not  had  to  active  treatment.  Patient  i.s 
not  seen  until  after  the  ett'usion  ;  bloodletting  and  purgatives  ])0\verles9 
to  remove  clot,  or  to  prevent  further  escape  of  blood.  Rest  in  sitting 
posture,  with  a  nutritious  but  unstimulating  diet,  Avill  ettect  all  that  is 
possible. 

CEREBRAL  INFLAMMATION.— The  study  of  l)rain  diseases  hardly 
sufficiently  advanced  to  permit  of  a  certain  diagnosis  between  inflamma- 
tion of  substance  of  brain  {cerebritis),  and  that  of  membranes  {meningitis). 
Distinction  not  of  great  importance.  In  only  a  few  instances  does  men- 
ingitis, or  cerebritis,  occur  alone.  In  majority  of  cases  the  two  affec- 
tions are  combined  (encephalitis). 

1.  Simple  Meningitis. — From  Mv^viy^,  a  membrane;  terminal  -itis.  Sy- 
non.  Encephalitis  Membranosa. — Inflammation  of  arachnoid  and  jiia  ma- 
ter ma}^  arise  without  apparent  cause  ;  or  may  be  produced  by  a  fall  or 
blow,  by  extension  of  disease  from  ear  or  nose,  or  by  exposure  to  the 
sun.  May  also  arise  from  poison  of  syphilis  or  rheumatism :  from  de- 
posit of  tubercle  (see  Tubercular  Meningitis). 

vSymptoms.  Fever.  Acute  pain  in  head.  Irritability,  with  early  and 
violent  delirium.  Frequent  flushings  of  face,  followed  by  pallor.  Rapid 
pulse.     Muscular  twitchings.     Prostration,  and  coma. 

Inflammation  of  membra  7ies  over  convexity  of  brain:  First,  a  rigor;  or  in 
children,  a  convulsion.  Then,  skin  gets  hot  and  dry;  pulse  hard  and 
rapid  ;  bowels  confined.  Intense  headache,  increased  by  sound  or  move- 
ment. Face  alternately  flushed  and  pallid  ;  conjunctiva?  injected,  eyes 
suffused  and  staring.  Noisy  and  violent  delirium  sets  in  early.  Great 
restlessness ;  muscular  twitchings ;  strabismus.  Vomiting.  At  end  of 
three  or  four  days,  fever  lessens;  pulse  flags;  tongue  gets  brown  and 
dry;  excitement  diminishes;  delirium  apt  to  pass  into  coma.  In  a  few 
days  more,  intense  prostration.  When  disease  ends  favorably,  improve- 
ment very  gradual:  no  critical  sweat  or  diarrhoea. 

Meningitis  confined  to  base:  Diagnosis  very  difficult.  Sometimes,  de- 
lirium at  commencement ;  great  fever;  contracted  jiupils;  raving;  fre- 
quent pulse;  clenching  of  teeth  ;  and  retraction  of  head.  Coma.  Death, 
as  from  apoplexy.  In  other  cases,  pain  in  temples;  vomiting;  consti- 
pation; wry-neck;  loss  of  appetite;  a  desire  for  repose.  After  a  few 
days,  vacant  look;  dejection;  intelligence  clear ;  pulse  and  skin  natural. 
Headache,  unrelieved.     Coma,  ending  in  death. 

Inflammation  of  dura  mater:  Frequently  the  result  of  violence:  of  dis- 
ease of  cranial  bones,  particularly  of  petrous  portion  of  temporal  or  of 
ethmoid.  Chronic  affections  of  ear  and  nose  in  children,  regarded  as 
trifling,  may  end  fatally  by  rapid  extension  of  morbid  action  to  dura 
mater. 

Treatment.     See  Acute  Encephalitis. 

2.  Cerebritis. — From  Cerebrum,  the  brain ;  terminal  -itis.  Partial  in- 
flammation of  brain  substance  without  meningitis.     Of  rare  occurrence. 

Symptoms.  Persistent,  deep-seated  pain  in  head ;  general  malaise 
and  vomiting;  impairment  of  vision  and  hearing;  confusion  of  ideas, 
with  failure  of  memory;  convulsive  paroxysms,  ending  in  paralysis  or 
coma.  Mental  disturbance  varies  considerably  according  to  part  of 
brain  affected.  After  three  or  four  days  there  may  be  a  copious  effusion 
of  serum  :  sj'mptoms  of  compression.  Sometimes,  inflammation  ends 
in  abscess;  suppuration  occurring  without  exciting  any  suspicion. 

TreaTxMent.     See  Acute  Encephalitis. 

3.  Acute  Encephalitis. — From  ' Efy<.ifalo^^  that  which  is  in  the  head; 

5 


66  CEREBRAL    INFLAMMATIOX. 

terminal  -itis.  Synon.  Jleningo-cerebritis ;  Phrenitis. — The  inflammation 
gives  rise  to  more  or  less  complicated  phenomena  during  life,  according 
to  degree  and  extent  to  which  brain  and  its  membranes  are  involved. 
After  death,  traces  of  its  j^ower  are  found  in  form  of  meningeal  conges- 
tion, with  effused  lymph,  or  serum,  or  pus;  appearances  of  vascularity, 
varying  from  bloody  points,  or  a  scarlet  tinge,  to  a  dusky  redness  about 
affected  part  of  brain ;  with  occasionally  softening,  or  suppuration  of 
cerebral  substance. 

Symptoms.  Earliest  indications,  fever;  nausea  and  vomiting;  acute 
headache;  sharp  and  hard  and  irregular  pulse;  constipation;  impa- 
tience of  light  and  sound ;  watchfulness ;  a  look  of  oppression  or  sul- 
lenness ;  suffusion  of  eyes ;  confusion  of  thought,  or  even  delirium. 
These  symptoms  most  marked  when  meningitis  predominates.  After 
from  twelve  hours  to  two  days,  second  stage  of  the  complaint  sets. in — 
period  of  collapse.  State  of  stupor;  articulation  difficult  or  indistinct; 
vision  and  hearing  dull ;  pupil — from  having  been  contracted  to  a  pin's 
point — becomes  dilated;  perhaps  squinting,  and  paralysis  of  muscles  of 
eyelids;  frequent  twitchings  of  muscles;  ghastly  countenance;  sordes 
on  gums  and  teeth;  cold  sweats;  relaxation  of  sphincters;  convulsive 
paroxj^sms,  paralysis,  and  profound  coma,  which  usually  soon  ends  in 
death.  Occasionally  the  first  symptom,  a  sudden  attack  of  convul- 
sion ;  perhaps  occuri-ing  without  previous  illness,  or  preceded  by  head- 
ache and  slight  complaints  which  have  passed  on  unnoticed.  Convul- 
sion generally  long  and  severe  :  may  be  followed  immediately  by  coma, 
which  is  soon  fatal ;  or  it  may  i-ecur  frequently  at  short  intervals,  and 
pass  into  coma  at  end  of  twenty-four  hours.  When  nausea  and  vomit- 
ing are  earliest  symptoms,  disease  has  probably  had  its  origin  in  cerebral 
pulp ;  when  attack  begins  with  a  convulsion,  the  inflammation  has 
started  from  arachnoid  or  pia  mater  ("Watson). 

In  all  forms  of  this  dangerous  complaint,  sj'mptoms  variable.  Caution 
necessary  against  insidious  character  which  many  cases  assume,  and 
deceitful  appearances  of  amendment.  Disease  I'are.  ^lay  end  fatally 
in  a  few  hours,  or  patient  may  struggle  on  for  two  or  three  weeks. 

Treatment.  Calomel  and  jalap,  followed  by  sulphate  of  magnesia, 
140.  Jalap  and  senna,  151.  Calomel  and  scammony,  or  jalap,  159. 
Antimony  and  sulphate  of  magnesia,  152.  Croton  oil,  168.  Castor  oil 
and  turpentine  enema,  190.  "  More  recoveries  from  head-affections  of 
the  most  alarming  aspect  take  place  under  the  use  of  very  strong  purg- 
ing than  under  any  other  mode  of  treatment"  (Abercrombie).  Iodide 
of  potassium  (grs.  .3  to  8  every  four  or  six  hours).  Tincture  of  aconite. 
Milk  diet.  Head  to  be  shaved.  Pounded  ice  in  a  bladder,  to  scalp ;  or 
cold  evapoi-ating  lotions.  273.  Excess  of  temperature  reduced,  and  ex- 
citement calmed,  by  ])ouring  cold  water  in  a  stream  upon  vertex  of 
head.  It  must  be  remembered  that  cold  to  head  exercises  a  very  de- 
pressing influence :  hence,  case  must  be  carefully  watched.  As  soon  as 
extreme  collapse  sets  in  from  exhaustion  of  nervous  force,  stimulants 
will  be  needed.  Ammonia.  Spirit  of  ether.  Brandy  or  wine.  Strong 
beef  tea.     Milk  or  cream. 

Remedies  sometimes  employed :  General  and  local  bleeding.  Drastic 
purgatives,  long  continued.  Antimonj'.  Mercury.  Digitalis.  Opium 
combined  with  antimony.  Blisters,  or  ointment  of  tartarated  antimony 
to  scalp,  after  shaving.     Mustard  pediluvia. 

4.  Chronic  Encephalitis. — Ma}^  follow  acute  inflammation :  more  fre- 
quently an  iudt'])ciident  primary  disorder. 

Symptoms.  Of  a  subacute  character.  Very  diversified  :  allied  to 
those  which  mark  commencement  of  insanity.  Great  mental  excite- 
ment, or  depression.      Delusions.      Hesitation  in   speaking,   or  slight 


CEREBRAL    INFLAMMATION.  67 

Rtammei'ing.  Stiffness  of  some  nuiseles.  Slight  lieadache.  Loss  of 
appetite.  Constipation.  Irregularity  of  pulse.  Subsequently,  symp- 
toms become  more  marked  :  memory  fails,  external  senses  get  impaired, 
paralysis,  break  up  of  general  health.  Disease  may  last  for  only  a  few 
months,  or  for  years. 

Treatment.  Attempts  to  combat  symptoms  as  they  arise.  Hygienic 
measures  to  improve  general  health.  Attention  to  digestive  and  ute- 
rine organs.  Cod-liver  oil.  Small  blisters  behind  ears,  often  repeated. 
A  seton  in  nucha.  Sometimes  inunction  of  shaved  scalp  with  iodide  of 
potassium,  or  red  iodide  of  mercury  ointment. 

5.  Softening-,  Induration,  and  Tumors  of  Brain. — General  symptoms 
of  cerebral  softening  :  More  or  less  severe  and  persistent  pain  in  head. 
Sudden  and  short  attacks  of  vertigo.  Diminution  of  intellectual  power, 
embarrassment  in  answering  questions,  depression  of  spirits,  tendency 
to  shed  tears  on  any  excitement.  Prickings  and  twitchings  in  limbs, 
perhaps  pain  or  numbness.  Tendency  to  sleep,  especiall}"  after  meals. 
More  or  less  impairment  of  vision  and  hearing.  In  inflammatory  soft- 
ening, headache  more  acute  than  in  other  forms ;  limbs  become  the  seat 
of  painful  cramps,  stiffness,  or  contractions;  paralj'sis  with  spasm  not 
uncommon;  permanent  contraction  of  flexor  muscles  of  one  or  both 
extremities;  general  sensibility  more  acute.  In  second  stage  of  either 
inflammatory  or  non-inflammatory  form  :  Paralysis  of  a  limb,  or  of  one 
half  of  body,  coming  on  suddenly  without  loss  of  consciousness.  Pa- 
tient easily  confused  ;  has  a  ditficulty  in  answering  questions,  and  in 
making  himself  understood.  Feebleness;  weak  and  intermitting  pulse. 
Vomiting  and  constipation.  Difficulty  in  emptying  bladder.  Involun- 
tary escape  of  stools.  Eespiration  labored;  at  last  becomes  stertorous. 
Coma,  ending  in  death.     Disease  most  common  after  fiftieth  year. 

Acute  Eamollissement  (from  RamoUir,  to  make  soft),  or  red  softening  of 
brain,  one  of  the  terminations  of  inflammation.  Softening  usually  par- 
tial ;  affected  portion  reduced  to  consistence  of  cream.  Symptoms,  as 
described  in  preceding  paragraph.  When  resulting  from  acute  inflam- 
mation, parts  which  usually  suffer  are,  corpus  callosum,  septum  lucj- 
dum,  fornix,  and  cerebral  substance,  around  ventricles.  Softened  struc- 
ture sometimes  infiltrated  with  pus ;  occasionally  purulent  matter  con- 
tained in  a  well-defined  cavity — abscess  of  the  brain. 

White  softening  occurs  from  conditions  the  opposite  to  those  of  in- 
flammatory form.  Met  with  in  aged  persons.  Insufficient  supply  of 
blood  to  brain  ;  owing  to  disease  of  cerebral  arteries,  or  obstruction  by 
fibrinous  masses.  Probably  leads  to  fatty  degeneration  of  brain  tissue. 
Portions  most  frequently  affected,  gray  matter  of  convolutions  at  base, 
optic  thalami,  corpora  striata. 

Softening  of  cerebellum:  Attended  with  fixed  pain  at  back  of  head, 
especially  on  diseased  side.  Occasionally,  amaurosis;  hemiplegia  or 
paraplegia;  a  tendency  to  walk  backwards;  tottering  gait;  vertigo; 
semi-convulsive  agitation  of  limbs;  obtuse  hearing;  aphonia.  No  two 
cases  exactly  alike.  Abscess  of  cerebellum  sometimes  due  to  disease  of 
ear  and  mastoid  cells. 

Induration  of  brain :  Termination  of  acute  or  chronic  inflammation. 
Indurated  portion  of  small  extent:  presents  appearance  of  wax,  or 
white  of  egg  boiled  hard. 

Simple  and  malignant  tumors^  deposits  of  tubercle,  syphilitic  gummatous 
growths,  and  hydatids  have  been  found  in  brain.  Indications  of  such 
very  obscure.  Most  frequent  symptoms,  headache,  sickness,  giddiness, 
mental  depression  with  confusion,  partial  paralysis,  epileptiform  con- 
vulsions. 


68  CEREBRAL   INFLAMMATION. 

6.  Tubercular  Meningitis. — Sj-non.  Acute  Hijdrocqjhalus ;  Water  Brain 
Fever.  Acute  inflammation  of  brain  not  uncommon  in  children  under 
five  years  of  age.  The  disease  ma}"  occur  in  those  previously  healthy, 
when  it  is  a  form  of  simple  encephalitis.  Most  frequently  the  children 
are  scrofulous;  the  inflammation  being  a  result  of  tubercular  deposit  in 
brain  or  membi*aues.  It  is  then  known  as  tubercular  meningitis.  For- 
merly named  acute  hydrocephalus. 

Symptoms.  Various  and  uncertain.  For  convenience  can  be  divided 
into  three  stages.  First  or  premonitory  stage:  Indications  of  malnutri- 
tion. Signs  of  strumous  diathesis.  Short  dry  cough ;  peevishness  ;  in- 
tolerance of  light  and  sound ;  headache,  giddiness,  and  other  warnings 
of  cerebral  congestion;  fever,  with  exacerbations  and  remissions;  ca- 
pricious appetite;  tongue  furred,  and  breath  offensive;  sickness  and 
constipation.  Child  drowsy,  yet  restless ;  moans  or  grinds  his  teeth  ; 
wakes  in  alarm  and  sci'eams;  frequently  becomes  delirious. 

After  four  or  five  days  second  stage  reached.  Child  wishes  to  be  left 
quiet.  Countenance  alternately  flushed  and  pale,  expressive  of  suff'er- 
ing ;  eyes  closed  and  eyebrows  knit.  If  old  enough  to  reply  to  ques- 
tions, complaint  made  of  headache  and  weariness  and  sleeplessness ; 
frequent  exclamations — '■  Oh  my  head."  Pulse  gets  irregular;  dimin- 
ishes in  frequency,  perhaps  falling  from  120  to  80.  Eemission  of  all 
symptoms.  Amendment  of  short  duration.  Stupor  and  heaviness  come 
on.  Squinting.  Child  lies  insensible,  probably  picking  his  nose  and 
lips  with  tremulous  fingers.  Convulsions;  perhaps  paralysis.  Urine 
and  fffices  passed  unconsciously. 

Transition  to  third  stage,  at  end  of  a  week  or  two,  efl'ected  gradually 
by  drowsiness  passing  into  profound  coma.  Pulse  gets  very  feeble, 
extremities  lose  their  warmth,  cold  clammy  sweat  breaks  out.  Par- 
alysis, perhaps  convulsions.  Sometimes  death  does  not  occur  for  several 
days. 

Most  diseases  of  the  brain  in  children  which  interfere  with  cerebral 
circulation,  impede  more  or  less  the  venous  circulation  in  the  eye. 
Hence  in  tubercular  meningitis  characteristic  appearances  may  be  ob- 
served at  fundus  of  eyeball,  by  ophthalmoscope,  before  convulsive  period 
sets  in.  These  are,  (1)  Pei-ipheral  congestion  of  papilla,  with  spots  of 
congestion  in  retina  and  choroid.  (2j  Dilatation  of  retinal  veins  around 
papilla.  (3)  Varicosity  and  flexuosity  of  these  veins.  (4)  Thrombosis 
of  same.  And  (5)  in  some  instances,  serous  infiltration  with  retinal 
hemorrhages  from  rupture  of  veins  (Bouchut). 

Tubercular  meningitis  in  adult  usually  preceded  by  history  of  pre- 
vious lung  affection.  Amelioration  of  chest  disease.  Symptoms  may 
early  assume  an  apoplectic  or  a  convulsive  form.  More  frequently  they 
come  on  gradually  with  vomiting,  slight  fever,  acute  pain  in  head;  pa- 
tient seems  unable  to  collect  his  thoughts,  is  peevish  and  irritable,  de- 
sires only  to  be  left  quiet;  there  may  be  mutism  and  somnolence; 
pulse  irregular  and  feeble.  In  second  stage,  depression  increases; 
greater  mental  dulness  or  delirium;  clonic  or  tonic  sjDasms.  In  third 
stage,  sphincters  relax;  increasing  stupor ;  paralysis;  death. 

Treatment.  Bowels  to  be  cleared  out  by  calomel  and  jalap.  Iodide 
of  potassium,  with  small  doses  of  tincture  of  aconite,  according  to  age. 
Cold  evaporating  lotions  to  head,  278.  If  child  be  teething,  employ 
gum  lancet  when  gum  is  tender  and  hard  and  swollen.  Where  there  is 
depression  of  vital  powers  use  stimulants — ammonia,  ether,  port  wine. 
If  symptoms  be  subacute,  h^pophosphite  of  lime  or  soda  and  bark.  Cod- 
liver  oil.     Sea  air.      Pui-e  niillc. 

7.  Hypertrophy  and  Atrophy  of  Brain. — Hypertrophy  of  cerebral  hemi- 
S2)heres  has  occurred  in   children:  more  common   between  2U  and  30 


CHAPPED    HANDS — CHIMNEY-SAVEEPER'S    CANCER.  60 

years  of  h^g.  If  skull  increases  as  brain  i^ets  over-devclo])cd  there  may 
be  an  absence  of  symptoms,  until  a  sudden  attack  of  convulsions  ends 
in  death.  When  bony  case  does  not  enlarge,  there  are  necessarily 
indications  of  compression:  mental  disturbance,  varying  from  slight 
dulness  of  intellect  to  complete  idiotcy.  Headache;  vertigo;  loss  of 
muscular  power  or  paralj'sis;  unaltered  or  very  slow  pulse;  severe 
epileptic  convulsions.     Death  in  latter,  or  from  subsequent  coma. 

Atrophy  may  vary  from  a  complete  absence  of  cerebral  hemispheres 
incompatible  with  extra-uterine  life,  to  a  simple  incomplete  develop- 
ment of  certain  convolutions  above  ventricles.  When  atrophy  affects 
one  side  only,  life  may  be  uninterfered  with  for  some  time. 

CHAPPED  HANDS. — May  be  due  to  imperfect  drying  after  washing; 
to  use  of  irritating  substances, — common  yellow  soap,  &e. ;  to  cold ;  to 
wearing  coarse  woollen  gloves  which  fret  the  hand  when  moist  from 
jierspiration. 

Treatment.  Thorough  drying  after  washing.  Dusting  with  pow- 
dered starch  ;  spermaceti;  white  bismuth ;  oxide  of  zinc;  carbonate  of 
zinc.  Crlycerine  soap.  Pure  honey  soap.  Glycerine  and  water — equal 
parts.  Collodium.  Ointment  of  oxide  of  zinc.  Ointment  of  carbonate 
of  lead.  Ointment  of  subacetate  of  lead.  Ointment  of  spermaceti. 
Diluted  citrine  ointment,  305.  Ointment  of  balsam  of  Peru  and  sper-' 
maceti.  306.     Lotion  of  nitrate  of  lead  (gr.  10  to  fl.  oz.  j). 

CHICKEN-POX. — Synon.  Varicella. — A  trifling  infectious  complaint, 
almost  peculiar  to  infants  and  young  children.  Runs  through  all  its 
phases  in  six  or  eight  days.  Consists  of  an  eruption  of  pimples,  which 
on  second  day  become  converted  into  transparent  vesicles  surrounded 
by  slight  redness.  Eash  commences  on  shoulders  and  back,  and  after- 
wards affects  the  scalp,  but  often  sparges  the  face :  about  fourth  day  the 
vesicles  form  small  scabs,  which  rapidly  desiccate.  No  constitutional 
disturbance  of  importance  :  accompanying  pyrexia  slight. 

Occurs  but  once  to  same  person.  Has  a  short  incubation,  probably 
of  four  days.  Requires  no  treatment  beyond  attention  to  bowels,  and 
restricted  diet.  Quinine,  bark,  steel  wine,  or  cod-liver  oil  may  be  needed 
during  convalescence. 

CHILBLAIN. — From  the  Saxon  Cele,  cold;  blegen,  a  boil  or  ulcer; 
/.  c,  a  blain  caused  by  chilliness  or  cold  (Mayne).  Synon.  Pernio. — A 
subacute  inflammatory  swelling,  due  to  cold  and  the  premature  restora- 
tion of  the  circulation  by  heat. 

Symptoms.  A  feeble  circulation, — cold  feet  and  hands.  In  the  first 
stage,  swelling  and  slight  redness  and  pain  or  itching;  in  the  second, 
vesication  ;  in  the  third,  ulceration  or  sloughing.  Parts  most  exposed, 
and  where  circulation  is  weakest,  most  prone  to  suffer.  Occurs  in 
weakly  constitutions,  strumous  children. 

Treatment.  Bark  and  port  wine.  Milk:  nourishing  food.  Cod-liver 
oil.  Chemical  food,  405.  Fire  in  bed-room.  Warm  stockings  and  gloves. 
Avoidance  of  tight  shoes.  Friction  with  compound  camphor,  arnica, 
soap,  opium,  or  turpentine  liniment.  Painting  with  tincture  of  iodine. 
To  relieve  itching,  lime  liniment  or  glj^cerine.  When  vesication  or 
ulceration  occurs,  water  dressing  or  poultices;  collodium  and  castor  oil 
varnish,  285;  resin  or  turpentine  ointment.  Diluted  nitrate  of  mercury 
ointment.     Nitrate  of  silver. 

CHIMNEY-SWEEPER'S  CANCER.— A  rather  uncommon  form  of 
epithelial  cancer.     Very  rare  in  Scotland,   France,  &c.     Produced  by 


70  CHLOASMA — CHOLERA. 

irritation  of  soot  lodged  in  folds  of  scrotum,  in  individuals  predisposed 
to  cancer.     Sometimes  hereditary. 

Symptoms.  Commence  as  a  tubercle  or  wart.  After  a  variable  inter- 
val, a  fungous  sore  with  ragged  edges  forms;  which  spreads  and  causes 
great  pain,  and  presents  all  the  frightful  characters  of  malignant  ulcer- 
ation. Superficial  inguinal  glands  do  not  invariably  become  secondarily- 
affected.  General  health  breaks  down.  Death  sometimes  hastened  by 
hemorrhage. 

Treatment.  Destruction  of  the  soot-wart  by  chloride  of  zinc,  or 
supersulphate  of  zinc,  or  chromic  acid.  Extirpation.  When  disease  is 
more  advanced,  excision  may  retard  its  progress;  provided  inguinal 
glands  have  not  become  involved.  Sooner  or  later  there  is  sure  to  be 
a  return. — See  Cancer. 

CHLOASMA. — From  Xlod'^u)^  to  be  of  a  greenish-yellow  color.  Synon. 
Pityriasis  Versicolor ;  Macula  Hepatica ;  JAver  Spot. — A  parasitic  cuta- 
neous disease. — See  Tinea. 

CHLOROSIS. — Yvoiw  XXwphq,  green.  Synon.  Pallor  Virginum ;  Green 
Sickness. — A  peculiar  form  of  anaemia,  affecting  young  women  about  the 
age  of  puberty  The  red  blood  corpuscles  are  pale,  small,  and  diminished 
in  number.     The  serum  is  in  excess. 

Symptoms.  Wax-like  hue  of  countenance.  Pallor  of  skin,  Avhence 
popular  name  of  "green  sickness."  Deficient  or  depraved  appetite. 
Constipation.  Abundant  limpid  urine.  Weak  quick  pulse.  Hysteria. 
Pale  scanty  menstrual  discharge.  Leucorrhoea.  Listlessness.  Head- 
ache. Palpitations.  Backache.  Cardiac  and  vascular  murmurs.  En- 
largement of  thyroid.     Protrusion  of  ej^eballs. 

Treatment.  Good  living.  Pure  air.  Sea  bathing.  Chalybeates. 
Aloetic  aperients. — See  Anaemia. 

CHOL.XMIA. — From  X^Ary,  bile;  al,a«,  blood.  The  morbid  state  in 
which  bile  exists  in  the  blood,  owing  to  its  reabsorption  after  having 
been  formed  by  the  liver.     See  Jaundice. 

CHOLERA. — From  AoAa?,  the  bowels,  and  piw^  to  flow ;  or,  according 
to  some  authors,  from  XoXij,  bile,  and  piu)^  because  the  disease  is  said  to 
arise  chiefly  from  a  superabundance  of  acrid  bile.  Synon.  Epidemic. 
Malignant,  Asiatic,  or  Algide  (Algeo,  to  be  cold)  Cholera. — An  epidemic 
disease  of  such  severity  that  it  often  proves  fatal  in  a  few  hours ;  at- 
tended with  prostration,  coldness  and  lividity  of  surface,  vomiting, 
purging,  suppression  of  urine,  and  cramps  of  muscles  of  abdomen  and 
extremities.  Sometimes  preceded  by  simple  diarrhoea  :  more  frequently 
comes  on  suddenly  Avithout  warning. 

Symptoms.  Presents  three  stages :  (1)  Diarrhoea  and  vomiting,  prob- 
ably efforts  of  nature  to  expel  morbid  poison  (cholerine)  from  the  sys- 
tem. (2)  In  addition,  contracted  pupil,  spasms,  cramps,  coldness  of 
body,  and  intermitting  pulse.     (3)  Supi^ression  of  urine  :  collapse. 

In  detail  these  symptoms  ai-e:  Copious  vomiting,  in  most  cases. 
Purging,  in  most  cases:  stools  consist  of  an  abundance  of  water,  a  large 
quantity  of  epithelium  (imparting  a  rice-water  appearance),  a  little  al- 
bumen, a  trace  of  biliary  matter,  and  a  large  amount  of  salts  (especially 
chloride  of  sodium).  Severe  cramps  in  lower  extremities  and  abdo- 
men, rendering  muscles  as  hard  as  wood,  or  drawing  them  into  knot- 
like  masses.  Perhaps  albuminuria,  followed  by  suppression  of  urine. 
Urgent  thirst.  Diminished  circulation  and  impeded  respiration:  hence, 
intense  prostration,  icy  coldness  of  surlace    and   tongue  and   breath. 


CHOLERA.  71 

Lividity  or  bluenoss  of  lips  and  skin  generally.  Unnatural  and  whis- 
pering voice.  Shrinking  of  whole  body.  Pinched  features :  muddy- 
looking  complexion  :  sinking  of  eye,  with  contracted  and  immobile 
pupil,  and  flatteniiig  of  cornea:  the  whole  so  ])eculiar  that  the  expres- 
sion is  s])oken  of  as  the  fades  choleritica.  Notwithstanding  coldness  of 
surface,  complaint  is  made  of  oppression  ;  patient  often  likes  to  lie  un- 
covered. There  soon  follows  a  gradual  lessening  of  breathing;  a  thread- 
like pulse;  a  clear  intellect;  and  a  complete  arrest  of  circulation. — Pa- 
tients who  survive  eighteen  hours  frequently  show  signs  of  amendment : 
occasionally  get  well  rapidly ;  pulse  rising,  and  rice-water  evacuations 
being  replaced  by  stools  containing  bile.  But  often,  iijiprovement  only 
transient:  stools,  though  less  frequent,  are  free  from  bile;  suppression 
of  urine  continues;  and  death  is  preceded  by  headache,  drowsiness, 
tonic  or  clonic  spasms,  vomiting,  stertor,  and  coma.  In  more  favorable 
eases,  a  mild  febrile  exacerbation  follows  and  subsides  gradually  in  a 
few  days;  or  this  consecutive  fever  is  of  a  more  severe  type,  and  a  low 
typhoid  condition  follows. 

According  to  Dr.  Barraut,  a  contracted  and  immobile  pupil  precedes 
all  other  phenomena :  then,  suppression  of  urine ;  next  an  intermitting 
pulse,  followed  by  threadlike  peculiarity. 

Treatment.  Prophylactic:  Sanitary  laws  to  be  strictly  obeyed. 
Avoidance  of  all  doubtful  food  and  impure  water ;  of  too  long  abstinence 
from  food;  of  purgative  medicines;  of  over-fatigue;  of  intemperance, 
uncleanliness,  and  of  breathing  vitiated  air.  An}'-  tendency  to  diarrhoea 
(as  distinguished  from  premonitory  diarrboea)  to  be  checked  by  recum- 
bent 250sition ;  warm  bath;  sinapisms  or  linseed  poultices  to  abdomen; 
mucilaginous  drinks;  very  plain  food;  and  simple  astringents,  ether  or 
spirit  of  chloroform. 

Curative:  Only  three  points  seem  certain  :  The  purging  is  not  to  be 
checked  ;  opium  is  most  injurious  ;  and  the  patient  is  to  have  cold  water, 
or  soda  water,  and  ice  ad  libitum. 

Dr.  William  Stevens's  plan  was  more  successfully  used  than  any  other, 
on  a  large  scale,  in  the  prison  of  Coldbath  Fields,  during  1832  :  Patients 
presenting  premonitory  sj'inptoms  were  removed  into  an  observation 
ward,  where  an  even  temperature  was  constantl}^  maintained.  A  Seid- 
litz  powder  was  immediately  given  ;  if  sinking  were  felt  without  purg- 
iug,  thi'ee  or  four  teaspoonfuls  of  sulphate  of  magnesia  were  added  to 
powder.  These  agents  acting  freely,  plenty  of  thin  and  well-salted 
beef-tea  was  given  :  thirst  was  relieved  with  seltzer,  soda,  or  pure  water 
without  stint :  if  there  were  Q.nj  pains  a  sinapism  was  applied  over 
gastric  region.  Most  of  the  cases  were  thus  cured. — If,  however,  cramps, 
coldness,  or  sinking  of  pulse  came  on,  the  following  was  given  about 
every  half-hour:  Cliloride  of  sodium,  gr.  20;  carbonate  of  soda,  gr.  30; 
chlorate  of  potash,  gr.  7; — dissolved  in  water.  If  much  iri'itability  of 
stomach  existed,  a  large  sinapism  was  applied  ;  if  much  heat  or  burning 
pain,  an  additional  quantity  of  carbonate  of  soda  was  added  to  mix- 
ture.— In  cases  in  stage  of  collapse,  a  strong  solution  of  same  salts,  dis- 
solved in  hot  water  (100°  P.),  was  thrown  into  rectum,  and  repeated 
every  two  or  three  hours.  Sinapisms  to  stomach  and  between  shoulders. 
Frictions  with  warm  towels.     Air  of  ward  kept  perfectly  pure. 

Dr.  A.  C.  Macleod,  after  twenty  years  of  Indian  practice,  recom- 
mends :  Calomel,  in  ten-grain  doses,  everj^  half  or  even  every  quarter  of 
an  hour.  A  large  blister  to  loins.  Diffusible  stimulants,  regulated  by 
state  of  pulse.  Draughts  of  cold  water  ad  libitum.  Hot  water  bottles 
to  feet.  Assiduous  rubbing,  by  three  or  four  attendants,  of  abdomen 
and  extremities  with  cajuput  oil:  while  in  intervals  of  friction,  the  ab- 
domen is  to  be  covered  with  spongio-piline  sprinkled  with  the  oil. 


72  CHOLESTER^MIA — CHOREA. 

According'to  the  Cholera  Eeport  of  the  Eojal  College  of  Physicians 
(London,  1854),  no  appreciable  effects  followed  the  administration  of 
calomel,  even  after  a  large  amount  in  small  and  frequently-repeated 
doses  had  been  administered.  For  the  most  part  it  was  quickly  evacu- 
ated by  vomiting  or  purging,  or,  if  retained,  was  afterwards  passed 
from  bowels  unchanged. 

All  authorities  agree  that  patient  should  be  isolated  as  far  as  possible. 
To  be  surrounded  with  pure  air.  To  avoid  all  water  drawn  from  a 
well  near  any  sewer.  To  have  excretions  received  in  a  pan  containing 
some  disinfectant  fluid,  and  to  be  immediately  thrown  away.  Great 
caution  with  regard  to  diet  during  convalescence.  Broths  and  farina- 
ceous substances,  without  any  solids  whatever,  until  the  biliary  and 
renal  secretions  have  been  fully  re-established,  and  all  symptoms  have 
vanished. 

Remedies  which  have  had  strong  advocates :  Bleeding.  Emetics.  Purga- 
tive enemata.  Astringent,  and  opiate  enemata.  Injections  of  warm 
water,  or  of  saline  solutions,  into  veins.  Inhalation  of  oxygen  gas. 
Sulphur.  Sulphuric  acid.  Nitric  acid.  Nitro-hydrochloric  acid.  Qui- 
nine. Ipecacuanha.  Indian  hemp.  Opium.  Belladonna.  Subcutaneous 
injections  of  atropine.  Brandy.  Cajuput  oil.  Castor  oil.  Croton  oil. 
Creasote.  Carbolic  acid.  Chloroform.  Ether.  Sugar.  Acetate  of  lead. 
Logwood-  Nitrate  of  silver.  Infusion  of  Mikania  Guaco.  Petroleum. 
Phosphorus.  SumbuL  Turpentine.  Inoculation  with  quassia.  AYet- 
eheet  packing.  Cold  affusion.  Hot  air  baths.  Vapor  baths.  Hot  water 
baths.  Mustard  baths.  Ice  to  spine.  Galvanism.  Actual  cautery  along 
spinal  column.     Vesication  with  boiling  water.     Acupuncture  of  heart. 

CHOLESTER-ffiMIA- — From  XoXij,  bile;  (TT£peu^,  solid;  and  alfj-a,  blood. — 
Blood-poisoning,  owing  to  the  non-elimination  of  cholesterine  by  the 
liver. — See  Acholia. 

CHOEEA. — A'opeta,  a  dancing  or  jumping;  from  Xopbi;,  a  dance  accom- 
panied with  singing.  Synon.  Choreu  Sancti  Viti;  St.  Vitus' s  Dance. — A 
disease  characterized  by  irregular,  tremulous,  and  often  ludicrous  ac- 
tions of  voluntary  muscles,  especially  tliose  of  face  and  limbs;  there 
being  incomplete  subserviency  of  affected  muscles  to  the  will.  Has  been 
called  "  insanity  of  the  muscles." — Mostly  attacks  girls  between  sixth 
and  fifteenth  years,  though  not  uncommon  in  boys. 

Symptoms.  At  commencement,  slight  clonic  spasms  of  facial  muscles. 
By  degrees  almost  all  voluntary  muscles  affected.  Child  cannot  keep 
■quiet,  though  movements  are  to  some  extent  under  control  of  will : 
•constant  restlessness  of  hands  and  arms,  perhaps  of  legs,  most  marked 
when  patient  sees  she  is  watched.  Features  curiously  twisted  and  con- 
torted: vacancy  of  countenance.  Articulation  impeded.  Temper  irri- 
table. Irregular  appetite.  Perhaps  constipation.  One-half  of  body 
usually  more  affected  than  the  other:  disease  may  be  confined  entirely 
to  one  side — hemiehorea.     During  sleep,  irregular  actions  cease. 

During  progress,  endocarditis  or  pericarditis  ma}"  supervene.  An 
anaemic  mui-mur  sometimes  audible  at  base  of  heart.  Or  an  organic 
murmur  at  apex.  Eheumatic  fever  may  precede,  accompany,  or  follow 
chorea.     Rarely  terminates  in  epilepsy. 

Treatment.  Nourishing.food  and  general  care  will  cure  many  cases. 
Regulation  of  bowels,  and  of  uterine  functions  if  patient  has  reached 
the  age  of  puberty.  Saccharated  carbonate  of  iron,  396.  Steel  and  am- 
monia, 401.  Steel  and  arsenic,  399.  Quinine,  steel,  and  arsenic,  381. 
Steel  and  zinc,  414.  Oxide  of  zinc,  415.  Chemical  food,  405.  Hypo- 
phosphite  of  soda  or  lime,  with  bark,  419.     Cod-liver  oil,  389.     Nutri- 


CIIOUOIDITIS — CLUB-FOOT.  73 

tiousdiet:  milk.  Cold  shower  bath.  Sea  bathing.  Exercise  in  pure 
air.  Gymnastic  exercises.  Avoidance  of  mental  excitement,  long  les- 
sons, &c. 

Remedies  sometim.es  recommended:  Valerianate  of  ammonia.  Iodine. 
Calabar  bean.  Nitrate  of  silver.  Sulphate  of  copper.  Belladonna. 
Atropine.  Indian  hemp.  Stramonium.  Strychnia.  Turpentine.  As- 
safoetida.  Salts  of  cerium.  Inhalation  of  chloroform.  Sulphur  baths. 
Clalvanisra.     Blisters  to  spine. 

CHOROIDITIS. — From  X6f):ov,  skin  ;  eldo-;,  shape ;  terminal  -itis. — In- 
flammation of  the  choroid, — the  second,  or  vascular  and  pigmentar}^, 
tunic  of  the  eyeball.  Rarely  or  never  seen  alone  :  inflammation  rapidly 
spreads  to  neighboring  textures  of  eye,  producing  disorganization,  &c. 

Symptoms.  Intolerance  of  light,  lachrymation,  dimness  of  vision,  and 
supra-orbital  pain.  Engorgement,  more  or  less  extensive,  of  conjuncti- 
val vessels.  Displacement  of  pupil.  Thinning  of  sclerotic,  so  that  cho- 
I'oid  is  seen  through  it  (staphyloma  sclerotica?).  Opacity  of  cornea. 
Enlargement  of  globe  :  sometimes  suppuration  and  formation  of  fungous 
growths. 

Treatment.  Aperients.  Calomel  and  opium.  Arsenic.  Warm  baths 
and  fomentations.  Blisters  to  nape  of  neck.  Leeches.  Tartar  emetic 
ointment  to  temples. 

CHYLOUS  URINE. — From  XoXd<;,  the  nutritive  juice  formed  by  diges- 
tion,— ch3de.  Synon.  Chyluria ;  Galacturia ;  Chylodiabetes ;  Chylorrha'a 
Urinalis. — The  excretion  of  urine  of  a  milky  appearance  from  the  pres- 
ence of  fatty  matter  in  a  molecular  state.  In  addition,  there  is  gener- 
ally present  one  or  more  of  following, — blood  corpuscles,  fibrine,  albu- 
men, and  an  imperfect  albumen  (albuminose?).  The  urine  after  stand- 
ing a  short  time,  and  sometimes  whilst  in  the  bladder,  coagulates  into 
a  trembling  mass  resembling  blancmange  or  common  size.  Mostly  met 
with  in  natives  of  East  and  West  Indies,  Mauritius,  Brazil,  &c. 

Symptoms.  Lassitude.  Pains  about  loins  and  epigastrium.  Mental 
anxiety.  Debility,  and  loss  of  flesh.  Attacks  intermit:  urine  health}^ 
for  months,  and  then  chylous  for  months. 

Treatment.  Gallic  acid  (gr.  20 — 80  thrice  daily).  Decoction  of  man- 
grove bark  (Ehizophora  racemosa).  Tincture  of  perchloride  of  iron. 
Quinine  and  steel.  Ammonio-citrate  of  iron.  Cod-liver  oil.  Opium. 
Turkish  baths.  Salt  water  baths.  Tight  belt  worn  round  loins.  Change 
of  air, — a  bracing  temperate  climate.     Nourishing  diet. 

CIRRHOSIS  OF  LUNG.— From  Ktppd<;,  yellowish  or  tawny. — A  con- 
solidation or  contraction  of  more  or  less  of  pulmonary  tissue,  accompa- 
nied with  dilatation  of  bronchi. — See  Pulmonary  Condensation. 

CLITORITIS. — From  Katjttjp,  7jpi><;,  one  who  calls  or  invites;  terminal 
-itis.  Sj'non.  Inflammatio  Penis  Midiebris. — The  clitoris  occasionally  at- 
tacked with  subacute  inflammation;  leading  to  great  hypertrophy,  or 
to  cystic  degeneration.  May  also  be  excessivelj^  developed,  from  some 
congenital  malformation.  Sometimes,  the  seat  of  cancerous  infiltration. 
Entire  organ  found  diseased,  or  only  its  prepuce. 

Clitoris  occasionally  becomes  indurated,  with  or  without  enlargement. 
Said  to  be  due  to  self-abuse.  The  organ  frequently  amputated  to  cure 
this  practice,  but  with  very  doubtful  benefit. 

CLUB-FOOT.— Synon.  Talipes;  from  Talipedo  (talus  and  pedo),  to 
walk  on  the  ankles. — A  gradual  change  in  the  form  and  positions  of  the 


74  COCCYODYXIA COLIC. 

tarsal  bones,  owing  to  undue  action  of  certain  muscles.  May  be  con- 
genital or  acquired.  One  or  both  feet  atfected.  Four  principal  varie- 
ties : 

1.  Talipes  Equinus. — A  rigid  contraction  of  tendo-Achillis.  so  that 
the  heel  cannot  be  brought  to  the  ground,  and  the  patient  walks  on  the 
metatarsal  bones.  Horse-heel  sometimes  occurs  during  first  dentition. 
When  congenital — i.e.  not  caused  by  irritation  of  teething.  Avorms.  kc. — 
a  cure  is  generally  effected  by  subcutaneous  division  of  tendo-Achillis. 

2.  Talipes  Yarus. — The  heel  is  raised,  inner  edge  of  foot  drawn 
upwards,  and  outer  edge  rests  on  the  ground.  In  extreme  cases,  patient 
walks  on  dorsum  of  foqt  and  outer  ankle.  There  is  contraction  of 
muscles  of  calf  and  adductors  of  foot.  The  tendons  of  tibialis  anticus 
and  posticus,  as  well  as  that  of  flexor  longus  digitorum,  have  to  be 
divided ;  and  subsequently  the  tendo-Achillis. 

3.  Talipes  Yalgus. — The  reverse  of  T.  Yarus.  Outer  edge  of  foot 
drawn  upwards,  so  that  patient  rests  on  inside  of  instep  and  inner  ankle. 
Chiefly  due  to  contraction  of  tendons  of  peronei  muscles,  which  have 
therefore  to  be  cut. 

4.  Talipes  Calcaneus. — Elevation  of  toes  with  a  falling  of  heel,  so 
that  patient  walks  on  latter.  Owing  to  paralysis  of  muscles  of  calf, 
there  is  no  counteraction  to  contraction  of  those  of  anterior  tibio-fibular 
region.  Tendons  of  tibialis  anticus,  long  extensors  of  toes,  and  j^eroneus 
tertius  may  all  need  section  before  the  foot  can  be  brought  to  proper 
position. 

Mixed  or  compound  varieties  of  foregoing  not  uncommon.  Their  na- 
ture explained  by  the  names  :  Talipes  equino-varus,  T.  equixo-valgus, 

T.  CALCANEO-VALGUS. 

The  principle  on  which  subcutaneous  tenotomy  is  resorted  to,  is 
simple.  The  cut  surfaces  of  the  tendons  heal  by  connective  tissue,  which 
lengthens  the  tendon  and  admits  of  considerable  extension  while  re- 
cent.— In  some  cases  a  cure  can  be  obtained  without  operation  :  By 
removal  of  sources  of  irritation  ;  fomentations  and  frictions  of  rigid 
muscles;  tonics,  good  food,  sea-bathing,  (tc. ;  anti-rheumatic  remedies; 
and  the  proper  application  of  wood  or  gutta  percha  splints,  stiffened 
boots.  India  rubber  bands,  bandages,  and  other  mechanical  appliances. 

COCCYODYNIA. — From  Koxxu^,  the  cuckoo, — because  the  coccyx  is 
said  to  resemble  the  beak  of  this  bird;  and  odw^i,  pain.  Synon.  Coccy- 
algia;  Coccygodynia. — Pain  or  tenderness  about  coccyx.  After  a  fall  or 
blow,  childbirth,  violent  horse  exercise,  &c.,  inflammation  may  be  set 
up  in  fibrous  tissues  around,  and  muscular  attachments  to,  the  coccyx. 

Symptoms.  Pain  on  sitting  down  or  rising  from  chair,  on  walking, 
on  defecation,  &c.  Can  only  sit  on  one  hip  in  many  cases.  Xi^j  move- 
ment which  stretches  coccygeal  ligaments,  or  brings  sacro-coccygeal 
articulation  into  play,  causes  suffering:  sometimes  this  is  most  severe. 
Often  aggravated  h\  sexual  intercourse,  by  menstrual  flow.  Tender- 
ness on  pressure.  Occasionally  an  accompaniment  of  uterine  or  ovarian 
disease,  when  it  is  sympathetic  or  neuralgic.     Disease  very  chronic. 

Treatment.  Removal  of  any  uterine  or  ovarian  disease.  Improve- 
ment of  general  health.  iJ^ervine  tonics, — Quinine,  iron,  arsenic,  zinc. 
Warm  hip  baths.  Leeches.  Friction  with  ecjual  parts  of  belladonna 
and  mercurial  liniments.  Subcutaneous  injection  of  morphia,  314.  Sub- 
cutaneous division  of  muscles  and  ligaments  and  fascia?  connected  with 
coccyx,  so  as  to  set  the  bone  at  rest.  Complete  removal  of  coccyx,  or 
a  portion  of  it. 

COLIC. — From  Kwhr^,  the  large  intestine. — Characterized  by  severe 


COLLOID    CANCER — COMA.  75 

twisting  or  griping  pain  in  belly,  especially  about  umbilicus,  occurring 
in  paroxysms.  Pain  generally  relieved  by  pressure:  never  aggravated 
by  it.  Often,  vomiting.  Generally,  constipation.  An  absence  of  in- 
flammation and  fever.  While  attack  continues,  pulse  is  lowered j  sur- 
face of  body  cold;  countenance  anxious. 

Attacks  of  colic  due  to:  (1)  Indigestion,  accompanied  with  flatulence. 
Relieved  by  vomiting  or  purging,  or  eructation,  or  expulsion  of  wind 
by  anus. — See  Flatulence.  (2)  The  irritation  of  intestine  by  morbid 
secretions,  accumulation  of  fecal  matter,  &c.  Cured  by  hot  brandy  and 
water  with  spice  :  castor  oil.  (3)  Fright,  cold,  h^-steria,  gout :  demand- 
ing antispasmodics  like  ether,  chloroform,  belladonna,  opium ;  fomen- 
tations; perhaps  colchicum  and  opium.  (4)  Mineral  poisons,  such  as 
copper,  lead,  &c. — See  Copper  Colic;  Lead  Colic. 

Colic  not  to  be  confounded  with  pain  of  gastrodynia  or  gastralgia, 
enteritis  and  csecitis;  peritonitis;  perforation  of  bowel;  strangulated 
hernia,  or  ileus;  passage  of  hepatic,  or  of  renal,  calculi;  spasm  of  blad- 
der ;  uterine  colic ;  or  with  that  produced  by  aneurismal  or  other  tumors 
of  abdomen,  disease  of  spine,  &c. 

COLLOID  CANCER.  —  From  K6X).a,  glue.  Synon.  Alveolar  Cancer 
(Alveolus,  a  little  trench) ;  Cystic  Cancer  {Koanq,  a  bladder). — A  variety 
of  cancer,  consisting  of  a  clear  viscid  substance,  somewhat  resembling 
soft  gelatine  or  gum.  Most  frequent  primary  seats — the  stomach,  in- 
testinal canal,  omentum,  breast,  and  peritoneum;  secondarily,  it  aff'ects 
lymphatic  glands,  lungs,  &c.  A  section  of  a  colloid  cancer  presents  to 
naked  eye  a  clear,  soft,  gelatinous  mass,  intersected  and  surrounded  by 
tough  fibrous-looking  tissue  ;  the  intersections,  when  numerous,  forming 
small  cj^sts  or  cavities  filled  with  colloid  matter.  Such  a  cancer  often 
attains  considerable  size. — See  Cancer. 

COLOR-BLINDNESS. — Synon.  Achromotopsia ;  Acritochroviacy ;  Chro- 
inato  Pseudopsis ;  Daltonism.  —  The  inability  to  discriminate  between 
certain  colors  is  a  defect  which  is  quite  compatible  with  perfect  vision 
in  other  respects. 

Color-blindness  may  exist  in  three  forms:  (1)  Inability  to  discern 
any  color,  pi-operly  so  called,  so  that  black  and  white — i.  e..  light  and 
shade,  are  the  only  variations  of  tint  perceived.  (2)  Inabilit}'  to  dis- 
criminate between  nicer  shades  of  more  composite  colors,  as  browns, 
graj'S,  and  neutral  tints.  (3)  Inability  to  distinguish  between  primary 
colors,  red,  blue,  and  j-ellow ;  or  between  these  and  secondary  and  ter- 
tiary colors,  such  as  green,  purple,  orange,  and  brown  (Dr.  G.  Wilson). 

Defect  upon  which  false  perce^Jtion  of  colors  is  due,  consists  probably 
of  some  peculiar  organization  of  retina  and  that  part  of  brain  which  is 
essential  to  vision.  Generally  congenital:  cases  known  where  it  has 
been  induced  hj  disease  or  injur}^.  Quite  incurable.  Care  should  be 
taken  that  railway  servants  are  not  afflicted  with  color-blindness,  since 
mistakes  in  nature  of  signals  might  lead  to  a  serious  accident. 

COMA. — From  A'«)/j.a,  sound  sleep. — A  state  of  stujior  Avith  loss  of  con- 
sciousness, from  which  patient  is  roused  with  difficulty.  In  cams  (from 
A'afMiq,  heavy  sleep)  or  intense  coma,  there  is  not  only  loss  of  perception 
and  volition,  but  usuall}'  stertorous  breathing,  flaccid  limbs,  and  dilated 
pupils:  patient  cannot  be  roused. 

In  coma  coming  on  without  previous  disease  there  may  be  a  difficulty 
in  attributing  it  to  the  correct  cause.  Following  table  shows  chief 
points  of  distinction  : 


COMPRESSION    OF    BRAIN — COXCUSSION    OF    BRAIN. 


Pressure  of  Fradnred  Bone  or  Apoplectic 

Clot. 

1.  Patient  cannot  be  roused. 

2.  Vomiting  sometimes. 

3.  Snoring  and  difficult  breathing. 

4.  Slow,  irregular,  intermitting  pulse. 

5.  One  or  both  pupils  widely  dilated,  ac- 

cording as  pressure  is  unilateral  or 
bilateral. 

6.  Face  pale.     Cold  clammy  sweats. 


Concussion. 

1.  Kecovery  to  a  slight  extent  soon  after 

injury. 

2.  Vomiting  in  favorable  cases. 

3.  Breathing  easy. 

4.  Fluttering,  or  feeble  pulse. 

5.  Pupils  natural,  but  insensible  to  light. 


6.  Countenance  but  little  changed.    Body 
cold  and  pale. 


Poisoning  hy  Opium. 

1.  Can  at  first  be  roused  by  loud  noises. 

2.  Vomiting  sometimes,  with  slight  eflbrts 

at  reaction. 

3.  Breathing  slow  and  stertorous. 

4.  Weak  and  soft  pulse. 

5.  Pupils   usually  much  contracted,  and 

insensible  to  light. 

6.  Countenance  livid.     Clammy  sweats. 


Intoxication. 

1.  Can  be  momentarily  roused. 

2.  Vomiting  in  early  stage. 

3.  Stertor  absent,  or  not  loud. 

4.  Pulse  quick. 

5.  Pupils  contracted  or   dilated ;    often 

the  latter. 

6.  General     appearance     characteristic. 

Smell  of  alcohol  in  the  breath. 


Numerous  cases  of  apoplex}^  occurring  in  the  streets  have  been  mis- 
taken for  examples  of  drunkenness.  Practitioner  cannot  be  too  cautious 
-in  his  diagnosis. — See  Apoplexij ;  Poisoning ;  Alcoholism. 

COMPRESSION  OF  BRAIN.— From  Comprimo,  to  squeeze  together.— 
May  he  produced  by  extravasation  of  blood  or  serum  ;  fracture  of  skull, 
with  depression  of  lione  ;  bony  excrescence  ;  some  foreign  body, — a  bul- 
let, portion  of  spike,  &c. ;  by  abscess  and  tiimors  of  brain.  Symptoms 
are  essentially  those  of  apoplexy. 

CONCUSSION  OF  BRAIN.— From  Concutio,  to  shake.— Signalized  by 
fainting,  sickness,  stupor,  insensibility,  and  loss  of  all  muscular  power, 
succeeding  immediately  to  some  act  of  external  violence.  Patient  may 
rally  quicklj-,  or  not  for  many  hours ;  or  he  may  die  suddenly,  or  at 
end  of  some  daj's.  After  death,  no  lesion  may  be  detected ;  or  a  lacera- 
tion of  some  part  of  brain  ;  or  a  general  softening  of  cerebral  substance. 

Symptoms.  Vary  according  to  degree  of  concussion.  When  shock 
has  been  slight,  state  of  unconsciousness  soon  recovered  from  :  com- 
plaint only  made  of  confusion  of  ideas,  faintness,  sickness,  chilliness, 
drowsiness,  ringing  noises  in  ears.  In  more  severe  forms,  insensibility 
continues  longer.  Patient  lies  as  if  in  deep  sleep;  pupils  insensible  to 
stimulus  of  light ;  surface  pale  and  cold  ;  muscles  flaccid  ;  pulse  flutter- 
ing or  feeble;  sphincters  relaxed;  breathing  often  scai'cely  perceptible. 
When,  after  variable  interval,  partial  recovery  ensues,  there  is  confusion 
of  thought;  inability  to  articulate  distinctly;  often,  severe  vomiting; 
sometimes,  paralysis  of  one  or  other  extremity.  In  worst  cases,  indi- 
vidual is  felled  to  ground  by  the  shock,  and  dies  on  the  spot. 

Whole  nervous  system  now  and  then  receives  a  jar  by  railway  acci- 
dents, without  immediate  symptoms  being  develojied.  In  course  of  a 
few  daj's  there  may  be  diminution  of  power  of  motion;  one  or  more 
fits  of  epilepsy;  squinting,  or  impairment  of  sight;  deafness,  or  trouble- 
some noises  in  ears.  These  symptoms,  after  a  variable  duration,  may 
pass  off:  occasionall}'  they  are  precursors  of  serious  cerebral  or  spinal 
disease. 

Treatment.    Patient  to  be  watched  carefully.    Make  sure  that  there 


CONCUSSION    OF   SPINAL    CORD — CONJUNCTIVITIS.  77 

is  no  fracture  or  dislocation.  If,  on  recovery  from  shock,  there  be  ex- 
cessive reaction,  cold  to  head.  Two  or  three  drops  of  croton  oil  on 
tongue.  Where  no  attempt  to  rally  is  made,  a  little  wine  or  brandy 
and  water.  Warmth  to  surface  of  body  and  extremities:  blankets, 
bottles  of  hot  water,  hot  bricks,  &c.  In  after-treatment,  a  mild  un- 
stimulating  diet ;  absolute  rest  from  all  mental  occupation  ;  bodily  repose 
and  quiet;  gentle  bitter  aperients. 

CONCUSSION  OF  SPINAL  CORD.— From  Concutio,  to  shake.— May 

arise  from  any  shock, — as  fall,  jump,  severe  blow,  &c. 

Symptoms.  At  first  slight  and  obscure.  Peculiar  tingling  (sense  of 
pins  and  needles)  in  extremities.  Increasing  weakness.  Difficulty  in 
passing  urine.  Coldness  and  numbness  of  legs;  gradually  increasing 
difficulty  in  walking.     Perhaps,  irremediable  paraplegia. 

Treatment.  Cases  become  sei'ious  from  neglect.  A  cure  usually  to 
be  effected  by  perfect  rest  in  bed  until  all  symptoms  have  passed  off. 
Nourishing  food.     Attention  to  bowels  and  bladder. 

CONJUNCTIVITIS.— From  Conjunctiva  (ConJKugo,  to  join  together), 
the  membrane  which  lines  the  eyelids,  and  covers  anterior  surface  of 
eyeball;  terminal  -itis.  Synon.  Ophthalmia. — Inflammation  of  mucous 
membrane  of  eye,  a  common  affection.  Some  authors  divide  the  oph- 
thalmias into  several  classes  :  for  practical  purposes  it  suffices  to  remem- 
ber the  varieties  to  be  presently  mentioned. 

During  violent  fits  of  coughing,  vomiting,  &c.,  blood  sometimes 
extravasated  beneath  conjunctiva,  owing  to  rujJture  of  a  small  vessel. 
Whether  patch  of  ecchyiaosis  be  small,  or  so  abundant  as  almost  to  con- 
ceal sclerotic,  absorption  soon  takes  place.  If  patient  be  anxious  for 
some  application,  a  piece  of  linen  dipped  in  cold  water  containing  a  few 
di'ops  of  tincture  of  arnica,  may  be  laid  over  eye. 

Effusion  of  serum  into  areolar  tissue  between  conjunctiva  and  sclero- 
tic is  called  chemosis.  When  oedema  is  abundant,  conjunctiva  becomes 
quite  elevated,  so  that  cornea  looks  as  if  it  were  sunk  in  a  deep  depres- 
sion. Swelling  subsides  as  disease  which  causes  pressure  on  conjunctival 
veins  disappears. 

1.  Catarrhal  Ophthalmia. — A  mild  form  of  inflammation  of  the  con- 
junctiva and  Meibomian  follicles.  Most  common  of  all  eye  diseases: 
caused  by  exposure  to  cold  and  wet,  sudden  changes  of  temperature,  &c. 

Symptoms.  Slight  pain,  or  sense  of  scalding.  Stiffness  and  dryness: 
a  feeling  of  pricking  or  roughness  about  the  eye,  as  if  sand  or  broken 
glass  were  under  upper  e3'elid.  This  sensation  caused  by  rubbing  of 
sensitive  eyelids  over  enlarged  vessels  of  sclerotic  conjunctiva.  These 
vessels  seen  to  be  of  a  bright  scarlet,  and  irregularl}'  arranged;  diftei-- 
ing  from  appearance  of  vessels  in  sclerotitis,  in  which  the}'  are  of  a  pink 
hue,  disposed  straight  and  regularly  like  radii  in  a  circle.  Natural 
secretion  from  conjunctiva  and  Meibomian  follicles  increased  in  quan- 
tity :  often  becomes  ])uritorm. 

Treatment.  Yields  readily  to  simple  treatment :  often  terminates 
favorably,  without  any  remedies.  At  outset,  if  there  be  obstinate  con- 
stipation, calomel  and  jalap,  140,  159;  or  a  dose  or  two  of  some  milder 
aperient,  141.  If  general  health  be  bad,  stimulants  or  tonics,  with  beer 
or  wine,  and  meat.  Where  there  is  plethora,  continue  purgatives  for 
two  or  three  days,  while  diet  is  restricted.  In  troublesome  cases,  a 
blister  behind  ear.  Arsenic,  52.  Iodide  of  potassium,  31.  Affected 
eye  can  be  rested  by  wearing  a  shade;  to  be  bathed  several  times  in 
day  with  warm  water.  Astringent  applications  rarely  needed :  occa- 
sionally, a  drop  or  tM'o  of  vinum  opii,  or  of  solution  of  niti'ate  of  silver 


78  CONJUNCTIVITIS. 

(gr.  2  to  fl.  oz.  j),  may  cut  shoi't  an  attack.  AVhen  discharge  is  abun- 
dant, edges  of  eyelids  should  be  smeared  with  some  sim])le  ointment  at 
night,  to  prevent  their  adhering  in  the  morning. 

2.  Purulent  Ophthalmia. — Same  disease  as  foregoing,  onl}-  much  more 
severe,  and  consequently  more  destructive.  Three  kinds:  Purulent 
ophthalmia  of  adults,  or  contagious  ophthalmia,  or  Egyptian  ophthal- 
mia; gonorrhceal  ophthalmia;  and  purulent  ophthalmia  of  infants. 

Symptoms.  In  purulent  ophthalmia  of  adults,  inflammation  very  intense, 
runs  a  rapid  course,  attended  with  violent  pain,  and  leads  to  formation 
of  large  quantities  of  thick  and  yellow  purulent  matter.  Eyelids  swell 
so  that  they  cannot  be  separated  sufficiently  to  expose  cornea;  chemosis; 
discharge  adheres  to  eyelashes  in  thick  drops.  Severe  pain  in  eye  and 
forehead.  Generally  much  constitutional  disturbance,  fever,  prostra- 
tion. Where  disease  does  not  yield,  inflammation  increases,  attacks 
cornea,  and  occasionally  internal  textures  of  eye  ;  extensive  sloughing 
takes  place;  and  when  sufferings  terminate  it  is  found  that  sight  is 
completely  lost. — It  is  contagious,  frequently  epidemic,  and  common  in 
hot  climates.  Military  life  appears  to  predispose  to  it.  Both  eyes  often 
affected ;  sometimes  simultaneously. 

Gonorrhosal  ophthalmia  differs  from  the  preceding  in  a  few  points  only. 
Thus,  it  is  the  most  severe;  rarely  limited  to  one  eye,  but  one  organ 
usually  attacked  two  or  three  days  before  the  other ;  caused  by  con- 
tact of  gonorrhoeal — or  even  leucorrhoeal — dischai"ge  with  conjunctiva. 
Frequently  ends  in  sloughing  of  cornea. 

Purulent  ophthalmia  of  infants,  or  ophthalmia  neonatorum,  generally 
commences  about  third  day  after  birth,  with  inflammation  of  that  part 
of  conjunctiva  lining  palpebrfe.  Edges  of  eyelids  adhere  ;  on  separating 
them  a  drop  of  thick  white  fluid  escapes.  As  inflammation  extends  to 
conjunctiva  covering  eyeball,  ej-elids  swell;  pui-ulent  discharge  in- 
creases ;  child  becomes  very  feeble  and  restless  and  fretful.  Disease 
may  remain  in  this  state  for  eight  or  nine  days;  if  not  then  relieved, 
ulceration  of  cornea  occurs,  and  very  destructive  consequences  ensue. 
Both  eyes  commonly  suffer;  either  at  same  time,  or  within  an  interval 
of  a  few  days.     Discharge  contagious. 

Treatment. — In  purulent  ophthalmia  of  adults  and  gonorrhoeal  oph- 
thalmia, no  need  for  violent  measures.  Eesult  to  be  dreaded  is  ulcera- 
tion and  sloughing;  morbid  processes  which  are  more  likely  to  be 
encouraged  by  bleeding  and  antimony  and  mercury  and  starvation, 
than  ly  any  other  agents.  At  commencement,  when  tongue  is  thickly 
coated,  an  active  purgative,  140,  151.  If  there  be  debility, — Ammonia 
and  bark,  371;  quinine,  379;  cod-liver  oil.  Animal  food.  Beer  or  wine. 
To  combat  restlessness  at  night, — Henbane;  camphorated  tincture  of 
opium;  ether;  morphia  and  Indian  hemp,  317.  Locally:  Injections  of 
solutions  of  alum  (gr.  8  or  10  to  w^ater  fl.  oz.  j),  under  eyelids,  every 
hour;  or  solution  of  nitrate  of  silver  (gr.  2  to  fl.  oz.  j)  may  be  employed, 
in  same  way,  about  every  eight  hours.  If  there  be  ulceration  of  cornea, 
it  may  sometimes  be  checked  by  early  application  of  solid  nitrate  of 
silver.  Pain  arising  from  application  must  be  relieved  by  warm  nar- 
cotic fomentations,  and  opium.  To  prevent  lids  from  adhering,  smear 
their  edges  at  night  with  diluted  citrine  ointment,  305. 

To  cure  purulent  ophthalmia  of  infants, — Magnesia;  castor  oil;  mer- 
cury and  chalk,  35.  Small  doses  of  ipecacuan  and  opium  powder.  Iodide 
of  potassium.  f]xamination  of  mother's  milk  :  if  it  be  poor  or  deficient 
in  quantity,  a  health}- wet-nurse.  Goat's  or  cow's  milk.  Liebig's  food,  4. 
Locally:  Bathing  of  eye  with  tepid  water:  injections  of  a  solution  of 
alnm  (gr.  5  to  water  fl.  oz.  j)  beneath  lids,  everj-  six  or  eight  hours. 
Injections  of  sulphate  of  zinc  (gr.  2  to  fl.  oz.  jj  in  severe  cases. 


CONSTIPATION.  79 

3.  Strumous  Ophthalmia. — A  disease  of  scrofLilous  and  other  children, 
occurring  generally  between  time  of  weaning  and  ninth  or  tenth  year. 

Symptoms. — Slight  conjunctival  and  sclerotic  redness;  with  formation 
of  little  phlyctenula3  or  pustules,  sometimes  of  ulcei'S,  on  cornea.  Copious 
h^chrj-mal  secretion  ;  irritability  of  nasal  and  buccal  mucous  membranes. 
Great  intolerance  of  light  (photojyhobia),  with  spasmodic  contraction  of 
eyelids.  Swelling  of  lips,  eruptions  behind  ears,  disordered  intestinal 
secretions.  Both  eyes  usually  affected.  Hot  tears  flowing  over  cheek 
often  produce  an  eruption  resembling  crusta  lactea. 

Treatment.  Good  nourishing  food.  Milk.  Beer.  Warm  clothing. 
Pure  air.  Occasional  doses  of  mild  laxatives.  Tonics, — Quinine,  arsenic, 
steel,  &c.  Cod-liver  oil.  Locally:  Warm  fomentations.  Use  of  a  green 
shade :  a  green  or  blue  veil.  Drops  of  wine  of  opium.  Sulphate  of  zinc 
or  alum  (gr.  2  to  fl.  oz.  j).  Spermaceti  ointment  to  edges  of  lids.  Blis- 
ters behind  ears,  or  to  nape  of  neck.     Flying  blisters  to  temples. 

4.  Granular  Conjunctiva. — The  conjunctiva,  particularly  palpebral 
portion,  is  found  red  and  uneven  and  granular.  So-called  ''  granulations" 
consist  of  inflamed  mucous  follicles  and  papilla) :  when  they  cause  much 
irritation,  opacity  of  cornea  may  result. 

Treatment.  Quinine.  Arsenic  and  steel,  399.  Good  diet.  Dabbing 
granulations  gently  with  undiluted  liquor  potassa;,  previously  everting 
lids.  Sulphate  of  copper.  Nitrate  of  silver.  Ointment  of  nitrate  of 
mercury.     Sulphur  ointment. 

CONSTIPATION.— From  Constipo,  to  crowd  thickly  together.  Synon. 
Obstipatio ;  Alvus  Adstricta  ;  Torpor  Intestinorum. — May  be  an  idiopathic 
attection,  or  may  arise  during  progress  of  any  acute  or  chronic  disease. 
By  habitual  costiveness  is  meant,  a  prolonged  departure  from  the  stan- 
dard natural  to  the  individual.  As  a  rule,  most  people  have  a  dail}' 
evacuation;  but  some  only  go  to  stool  every  second  or  third  day. 

Symptoms.  Functions  of  stomach,  liver,  and  pancreas  imperfectly 
performed.  A  sense  of  mental  and  bodily  opjiression.  Sallow  and 
pasty  complexion.  Dry  skin.  Scant}^  urine.  JSo  stools:  or  only  scanty 
motions,  pale,  clay-like,  and  very  offensive. — In  obstinate  cases :  A  loss 
of  all  power  for  exertion.  Headache.  Paljiitation.  Neuralgia.  Hyp- 
ochondriasis. 

Treatment.  Temporary  constipatmi :  Sulphate  of  magnesia,  manna, 
and  senna,  139.  Sulphate  and  carbonate  of  magnesia,  141.  Sulphate 
of  soda  and  taraxacum,  144.  Aloes,  senna,  and  jalap,  145.  Eesin  of 
podophyllum,  160.  Castor  oil,  164.  Calomel  and  jalap,  159.  Ehubarb 
and  magnesia,  105.  Croton  oil,  168.  Ehubarb  and  blue  pill,  171.  Gam- 
boge, aloes,  and  blue  pill,  174.  Simple  enemata,  188.  Castor  oil  and 
turpentine  enema,  190.  Ci'oton  oil  enema,  191.  Purgative  electuaries, 
194. — Officinal  purgatives  :  Confection  of  pepper.  Confection  of  scam- 
monj^.  Confection  of  senna.  Confection  of  sulphur.  Compound  decoction 
of  aloes.  Decoction  of  tai-axacum.  Elaterium.  Enema  of  aloes.  Enema 
of  sulphate  of  magnesia.  Extract  of  Barbadoes  aloes.  Extract  of  Soco- 
trine  aloes.  Compound  extract  of  colocynth.  Extract  of  jalap.  Purified 
ox  bile.  Calomel.  Mercury  and  chalk.  Blue  pill.  Infusion  of  rhubarb. 
Infusion  of  senna.  Eesin  of  jalap.  Carbonate  of  magnesia.  Sulphate 
of  magnesia.  Scammony  mixture.  Croton  oil.  Castor  oil.  Pill  of  Bar- 
badoes aloes.  Pill  of  aloes  and  assafoetida.  Pill  of  aloes  and  myrrh.  Pill 
of  Socotrine  aloes.  Compound  pill  of  gamboge.  Compound  pill  of  colo- 
cynth. Pill  of  colocynth  and  hyoscyamus.  Compound  rhubarb  pill.  Eesin 
of  podophyllum.  Tartrate  of  potash.  Acid  tartrate  of  potash.  Compound 
powder  of  jalap.     Compound  powder  of  rhubarb.     Compound  powder 


80  CONTUSIOXS    OF    ABDOMINAL   WALLS — CONVULSIONS. 

ofscammony.  Tartrate  of  soda  and  potash.  Phosphate  of  soda.  Precip- 
itated sulphur.  Syrup  of  senna.  Tincture  of  aloes.  Tincture  of  jalap. 
Tincture  of  rhuharb.  Tincture  of  senna.  Compound  tincture  of  benzoin. 
Wine  of  aloes. 

Habitual  Constipation:  Olive  oil.  Almond  oil.  Castor  oil,  164.  Ehu- 
barb  and  magnesia,  165.  Syrup  of  senna.  Sulphate  of  soda.  143,  144, 
148.  Pepsine  and  aloes,  155.  Steel  and  aloes,  154,  404.  Nitric  acid, 
senna,  and  taraxacum,  147.  Sulphates  of  magnesia  and  iron.  166.  Seid- 
litz  powders,  169.  Puritied  ox  bile,  170.  Crlycerine.  Factitious  Chel- 
tenham waters,  180.  Factitious  Carlsbad  waters,  182.  Simple  enemata, 
188.  Suppositories  of  soap,  or  cocoa  butter.  Quinine,  379.  Quinine 
and  nux  vomica,  387.  Zinc  and  nux  vomica,  409.  vStrychnia  and  steel, 
408.  Sulphate  of  zinc,  177.  Compound  tincture  of  benzoin.  Extract  of 
nux  vomica,  175.  Yalerianate  of  zinc  and  belladonna,  410.  Tar  pills, 
36.  Cod-liver  oil.  Pepsine,  420.  Nitro-hydrochloric  acid,  378. — Diet: 
Wholesome  and  digestible  food.  Pipe  fruits  in  morning.  Figs  or  prunes 
soaked  in  olive  oil.  Oatmeal  porridge.  Brown  bread.  Aerated  bread. 
Tobacco.  Tumblerful  of  spring  water  at  bedtime. —  General  rem edies : 
Daily  exercise.  Avoidance  of  too  much  sleep.  Sponge  or  shower  baths. 
Wet  compress  over  abdomen.  Friction  of  abdominal  walls.  Galvanism. 
Gentle  kneading  of  abdominal  walls.  Bowels  to  be  solicited  to  act  at  a 
regular  hour  daily. — See  Intestinal  Obstruction. 

CONTUSIONS  OF  ABDOMINAL  WALLS.— From  Contundo,  to  bruise, 
to  crush  to  pieces. — ilay  be  produced  by  kicks,  blows,  a  fall  upon  some 
prominent  object,  or  a  squeeze  between  buffers  of  two  railway  carriages, 
&c.  Consequences  often  very  serious.  A  blow  sometimes  causes  death 
immediately,  owing  to  syncope  from  shock  to  solar  plexus  of  sympa- 
thetic. In  other  instances  there  may  be  laceration  of  some  internal 
structure,  with  hemorrhage:  injured  individual  often  dies,  at  end  of  a 
few  hours,  from  combined  effects  of  shock  and  loss  of  blood. — Occasion- 
ally, contusion  causes  rupture  of  an  internal  organ,  with  extravasation 
of  contents.  There  may  be  no  external  symptom  of  injury;  and  yet 
tissues  of  gall-bladder,  liver,  spleen,  stomach,  intestinal  canal,  or  preg- 
nant uterus  be  torn  through.  Patient  either  dies  shortU'  from  collapse, 
or  hemorrhage :  surviving  these  dangers,  from  peritonitis  after  a  longer 
interval.  Instances  have  occurred  of  laceration  of  liver  or  kidney, 
where  sufferers  having  srot  over  first  effects  of  succeeding  inflammation 
have  subsequently  fallen  victims  to  blood-poisoning  from  absorption  of 
extravasated  fluids.  Lastly,  a  contusion  may  only  set  up  inflammatory 
action  in  a  limited  portion  of  the  abdominal  wall,  this  action  going  on 
to  suppuration. — See  Abscess  of  Abdominal  Walls. 

CONVULSIONS.— From  Convello,  to  overthrow,  to  annihilate,  &c. 
Synon.  Eclampsia ;  Hyperspasmia ;  Spasmus. — Convulsions  consist  of 
violent  and  involuntary  contractions  of  muscles  of  whole  body;  occur- 
ring in  paroxj'sms,  and  attended  with  unconsciousness.  Sometimes, 
contractions  partial,  of  considerable  duration,  and  attended  with  hard- 
ness of  affected  muscles  (tonic  spasms,  or  spastic  contractions^',  e.g.  com- 
mon cramp  and  tetanus.  Sometimes,  quickly  alternating  contractions 
and  relaxations  (clonic  spasm);  e.g.  subsultus  tendinum — a  catching  of 
the  tendons  of  hands  and  feet,  as  occurs  in  last  stages  of  low  fever. 

Convulsions  may  be  due  to  organic  disease  of  nervous  system,  or  to 
an  insufficient  supply  of  health}^  blood  to  nervous  centres;  to  irritation 
about  gums  or  alimentary  canal  (as  in  teething,  indigestion,  intestinal 
worms,  &c.);  to  renal  disease  and  albuminuria  (as  in  ura?mia  and  preg- 
nancy); to  a  morbid  state  of  the  blood  (as  in  hj'drophobia,  eruptive 


COPPER   COLIC — CORNEITIS.  81 

fevers,  whooping  cough,  &c.);  as  well  as  to  strong  and  sudden  mental 
emotion. 

Symptoms.  There  are  premonitory  symptoms,  or  an  absence  of  any 
warning.  All  the  voluntary  muscles  attacked;  or  there  may  be  only 
spasms  of  features,  one-half  of  body,  or  a  single  limb.  During  a  general 
paroxysm  there  is  distortion  of  features,  pallor  or  lividit}^  of  face,  star- 
ing eyeballs,  insensibilit}^  of  pupils  to  light,  grinding  and  gnashing  of 
teeth,  protrusion  of  tongue,  &c.  Involuntary  evacuations.  Laborious 
respiration.  There  will  be  only  one  attack,  or  several.  Followed  by  a 
tendency  to  sleep.  Seldom  a  fatal  result  unless  connected  with  severe 
disease. 

Treatment.  General  remedies:  Patient's  dress  to  be  loosened,  espe- 
cially clothing  about  neck.  To  be  placed  so  that  he  may  breathe 
pure  and  cold  air.  Cold  to  head  if  there  be  much  heat  and  flushing. 
Cold  affusion  to  head,  while  body  is  in  a  warm  bath.  Sinapisms,  or  hot 
bottles  to  extremities.  Mustard  footbaths.  Purgative  and  antispas- 
modic enemata,  190,  191.  Croton  oil,  one  or  two  drops  on  tongue. 
Emetics  of  ipecacuanha,  if  patient  can  swallow  and  there  be  evidence 
of  gastric  irritation,  2ol,  233.  Blisters,  dry  cupping,  to  nape  of  neck. 
Yenesection  ?  Leeches?  Opium,  where  thei*e  is  no  cerebral  disease. 
Hypodermic  injection  of  morphia,  314.  Belladonna  and  camphor,  326. 
Ether.  Chloroform  in  draughts,  and  by  inhalation,  313.  Sulphate  of 
aniline  (gr.  1  twice  or  thrice  daily).  Benzoic  acid,  49.  Lemon-juice. 
Vinegar. 

Puerperal  convulsions  :  Purgative  and  antispasmodic  enemata.  Inha- 
lation of  chloroform.  Induction  of  labor,  when  patient  is  undelivered: 
convulsions  often  cease  as  soon  as  liquor  amnii  is  evacuated.  When 
convulsions  occur  during  parturition,  expedite  delivery  by  forceps  or 
turning,  patient  being  previously  placed  under  influence  of  some  anaes- 
thetic. Venesection  and  leeches  are  worse  than  useless  where  there  is 
uremia  or  albuminuria.  In  convulsions  after  delivery,  hypodermic  in- 
jection of  morphia:  chloroform,  or  ether,  inhalation.  Benzoic,  or  acetic 
acid. 

Infantile  convulsions :  Attention  to  diet.  Cold  to  head,  while  body  is 
in  a  warm  bath.  One  or  two  grains  of  calomel  placed  on  tongue.  Ipe- 
cacuanha emetics,  if  stomach  be  loaded.  Lancing  gums,  w^here  they  are 
in  fault.  Magnesia  or  soda  in  dill  water,  if  thei'e  be  acidity  of  secre- 
tions. Calomel  and  scammouy,  oil  of  turpentine,  liquid  extract  of  fern 
root,  santonin,  decoction  of  pomegranate  i*oot,  if  there  be  intestinal 
worms. — See  Chorea;  Epilepsy ;  Hysteria;   Tetanus ;   Urcemia,  &e. 

COPPER  COLIC. — Paroxysmal  twisting  or  griping  pains  in  the  belly, 
due  to  chronic  poisoning  b}'  cop])er.     Aff^ects  copper-plate  printers. 

Symptoms.  Attacks  of  abdominal  pain,  coming  on  suddenlj^ :  aggra- 
vated by  pressure.  Nausea  and  vomiting.  Constipation  may  be  absent. 
Peculiar  sallow  hue  of  complexion:  countenance  anxious:  eyes  sunken 
and  lips  livid.     A  purple  line  around  gums. 

Treatment.  Sulphate  of  magnesia  and  sulphuric  acid,  142.  Sulphate 
of  soda  and  sulphuric  acid,  143.  Castor  oil,  164.  Enemata  of  warm 
water.  Morphia,  chloroform,  and  Indian  hemp,  317.  Ether  and  opium, 
85.  Iodide  of  potassium,  31.  Hot  baths.  Sinapisms.  Turpentine 
stupes.     Linseed  poultices. — See  Colic. 

CORNEITIS. — From  Cornea  {Cornu^  a  horn),  the  transparent  and 
nearly  circular  external  tunic  of  the  eyeball,  forming  the  anterior  sixth 
of  the  globe ;  terminal  -itis. 

1.  Acute  Inflammation.     Corneitis,  or  preferably  Keratitis  (Kipaq,  a 

6 


82  CORNEITIS. 

horn),  renders  the  polished  and  transparent  cornea  hazy,  dim,  and 
rough.     May  cause  it  to  look  like  ground  glass. 

Symptoms.  A  ci'eseentic  plexus  of  minute  vessels  can  be  seen  passing 
from  edge  of  cornea.  A  zone  of  pink  vessels  in  adjacent  sclerotic.  Ha- 
ziness of  cornea  with  opacity.  Abundant  secretion  of  tears.  Intole- 
rance of  light.  Strumous  children  and  subjects  under  twenty  years  of 
age  most  liable  to  it.  One  or  both  eyes  may  be  aifected :  sometimes 
one  eye  attacked,  just  as  the  other  is  getting  well.  Morbid  action  may 
last  for  months  and  leave  cornea  permanently  cloudy.  Occasionally 
ends  in  suppuration,  and  pus  gets  infiltrated  between  fibres  of  the  mem- 
brane. Softening  generally  takes  place  posteriorly-:  pus  makes  its  way 
into  anterior  chamber,  to  bottom  of  which  it  sinks;  when  it  assumes 
a  crescentic  foj-m — hyjjopyon.  AVhen  an  opening  occurs  anterioi'ly,  a 
perforating  ulcer  of  cornea  is  produced  through  which  ii'is  protrudes — 
staphyloma  iridis. 

Treatment.  Attention  to  biliary  and  intestinal  secretions.  Ehu- 
barb  and  magnesia,  mercury  and  chalk,  calomel,  or  castor  oil.  Iodide 
of  potassium  and  bark,  31.  Iodide  of  Iron,  32.  Cod-liver  oil.  Chemical 
food,  405.  Quinine.  Tincture  of  perchloride  of  iron.  Nourishing  diet 
with  milk.  Small  blisters  to  temples,  or  behind  ears.  Warm  fomenta- 
tion :  steaming  the  eyes.  Tincture  of  iodine  to  skin  of  lids.  Avoidance 
of  irritating  coUyria. 

2.  Syphilitic  Keratitis. — Sometimes  spoken  of  as  "chronic  interstitial 
keratitis."  The  result  of  inherited  constitutional  syphilis.  Affects  chil- 
dren and  young  persons,  especially  females.     Is  very  chronic. 

Symptoms.  A  diffused  haziness  beginning  at  centre  of  one  cornea. 
Tissue  gets  to  I'esemble  ground  glass.  No  tendency  to  ulceration. 
After  a  few  weeks  both  corner  become  affected.  Subjects  of  this  dis- 
ease have  a  coarse  and  flabby  skin,  pits  and  scars  on  face  and  forehead, 
cicatrices  of  old  fissures  at  angles  of  mouth,  sunken  bridge  to  nose,  and 
permanent  teeth  peculiar  for  smallness  and  bad  color  and  vertically 
notched  edges  (Hutchinson). 

Treatment.  Cautious  use  of  mercury,  avoiding  salivation.  Corro- 
sive sublimate  and  compound  infusion  of  gentian.  Mercurial  inunction 
behind  eai's.  Iodide  of  potassium.  Iodide  of  iron.  Ferruginous  tonics. 
Liberal  diet.     Cod-liver  oil. 

3.  Opacity  of  Cornea. — May  result  from  inflammation,  giving  rise  to 
effusion  of  tibrine  into  substance  of  cornea,  or  between  it  and  conjunc- 
tiva; or  it  may  be  the  consequence  of  a  cicatrix  following  an  ulcer. 

"When  opacity  is  cloudy  and  diffused,  as  from  keratitis,  appearance 
called  a  nebula  :  a  limited  white  patch,  such  as  results  from  a  cicatrix, 
is  known  as  albugo  and  leucoma.  Employment  of  acetate  of  lead  collyria, 
when  there  has  been  an  abrasion  of  cornea  or  conjunctiva,  has  led  to 
formation  of  a  permanent  white  deposit.  This  may  sometimes  be  gently 
scraped  away. 

4.  Ulcers  of  Cornea. — Occur  in  individuals  of  all  ages  where  powers 
of  life  have  been  lowered  by  illness,  insufficient  food,  strumous  disease, 
&c.  May  lead  to  perfbi^ation  of  cornea  with  escape  of  aqueous  humor, 
obliteration  of  antei-ior  chamber,  and  prolapsns  iridis.  To  be  cured  by 
attention  to  general  health.  When  the  ulcer  is  very  indolent,  local  use 
of  nitrate  of  silver.     Avoidance  of  irritating  collyria. 

6.  Conical  Cornea. — Synon.  Keratoconus ;  Staphyloma  Oornexe  Pellu- 
cidiim. — A  rare  malformation.  Cornea  found  exceedingly  convex,  giv- 
ing a  peculiar  sparkling  or  brilliant  appearance  to  eye.  Both  eyea 
iisually  affected,  though  often  unequally.  In  consequence,  an  almost 
total  deprivation  of  vision.  Causes  of  this  deformity  not  known.  In 
the  few  cases  which  have  been  examined  after  death,  apex  of  cornea 


CORYZA — COUGH.  83 

has  been  found  thinner  than  natural. — All  kinds  of  treatment  have 
been  fruitless.  But  patient's  vision  may  sometimes  be  partly  assisted 
by  a  deeply  concave  glass;  or  by  use  of  a  black  plate  with  a  trans- 
verse slit  along  its  middle,  fixed  in  spectacle-frame,  with  or  without  the 
glass. 

6.  Arcus  Senilis. — Synon.  Leueoma  Gerontotoxon ;  Macula  Cornece  Ar- 
cuata ;  Fatty  Degeneration  of  Peripheral  Portion  of  Cornea. — A  gradually 
increasing  opacity  of  circumference  of  cornea,  owing  to  fatty  degenera- 
tion. Generally  occurs  in  the  aged.  Indicative  of  fatty  degeneration 
of  heart. 

CORYZA. — From  Kdpa,  the  head;  C^w,  to  boil.  Synon.  Phinitis ; 
Graved 0 ;  Stillicidium  Narium  ;  Cold  in  the  Head. — Catarrhal  inflamma- 
tion of  Schneiderian  membrane  of  nose. — Often  quickly  relieved  by 
full  dose  of  opium.     Iodine  vapor,  259. — See  Catarrh. 

COUGH. — Synon.  Tassis. — A  sjnnptom  of  numerous  and  varied  dis- 
eases. Frequently  an  effort  to  expel  irritating  matters  from  bronchi 
and  air-cells.  Sometimes  an  idiopathic  affection. — See  Asthma;  Bron- 
chitis; Cronp ;  Hooping- Cough ;  Laryngismus  Stridulus;  Laryngitis; 
Phthisis-;  Pleurisy ;  Pneumonia,  &c. 

Treatment.  General  Remedies  :  Mucilage  of  gum  Arabic.  Mucilage 
of  tragacanth.  Decoction  of  Iceland  moss  (Cetraria).  Decoction  of  bar- 
ley. Infusion  of  dulcamara.  Infusion  of  linseed.  Infusion  of  marsh 
mallow.  Liquorice  jujubes  (consisting  of  gum  and  sugar  and  gelatine). 
Ammoniac  mixture,  237.  Balsam  of  Peru  with  mucilage.  Syrup  or 
tincture  of  Tolu.  Ammonia  and  senega,  235.  Antimonial  wine,  240.  Ipe- 
cacuan  wine,  241.  Powder  of  ipecacuan  and  opium.  Tincture  or  syrup 
of  squills,  236,  247.  Compound  squill  pills.  Spirit  of  nitrous  ether.  Spirit 
of  ether.  Spirit  of  chloroform.  Eectitied  pyroxylic  spirit.  Dilute  hydro- 
cyanic acid.  Laurel  water  (Aqua  laurocerasi,  min.  v  to  xxx).  Morphia, 
315,  317,  346,  347.  Opium,  213,  316,  324,  338,  345.  Camphorated  tinc- 
ture of  opium,  235,  319.  Sj-rup  of  poppies.  Conium,  335.  Henbane. 
Stramonium,  323.  Aconite,  330,  332.  Belladonna,  326,  344.  Indian  to- 
bacco, 88,  242.  Almond  oil.  Cod-liver  oil,  389.  Inhalation  of  steam,  tar 
vapor,  medicated  vapors.  Spray,  or  atomized  fluids,  of  weak  solutions  of 
tannic  acid,  perchloride  of  iron,  sulphate  of  zinc,  alum,  opium,  conium, 
&c.,  262.  Locally  to  chest  walls  :  Mustard  poultice.  Turpentine  stupes. 
Blisters.  Opium,  belladonna,  ammoniac  and  mercury,  chalybeate,  gal- 
banum,  pitch,  or  warm  plasters.  Liniment  of  chloroform,  or  opium,  or 
belladonna,  or  iodine,  properly  diluted.  Compound  liniment  of  camphor. 
Liniment  of  croton  oil,  207.  Ointment  of  tartarated  antimony.  Tartar 
emetic  embrocation,  206. 

Cough  from  Intestinal  L'ritation,  d-c. :  Lancing  gums.  Eemedies  against 
intestinal  worms.  Remedies  against  dyspepsia,  gastric  catarrh,  consti- 
pation, &c. 

Cough  from,  Enlarged  Tonsils,  &c.:  Astringent  gargles,  248,  249,  252, 
257.  Quinine,  379, 386.  Steel,  380,  392,  395,  403.  Phosphate  of  iron,  405. 
Iodide  of  iron,  382,  390.  Iodide  of  ammonium.  Phosjjbate  of  zinc,  414. 
Cod-liver  oil,  389.  Application  of  nitrate  of  silver.  Excision  of  tonsils. 
Amputation  of  elongated  uvula.  Potassa  fusa  has  been  applied  to  en- 
larged tonsils,  but  its  use  requires  great  caution. 

Nervous  and  Hysterical  Cough :  Valerian,  87.  Valerianate  of  quinine 
or  zinc,  93,  410,  411.  Assafoetida,  89.  Phosphate  of  zinc.  Nux  vomica. 
Compound  mixture  of  iron.  Citrate  of  iron  and  quinia.  (lalbanum  ; 
compound  pill  of  assafoetida.  Nitrate  of  silver  to  glottis.  Attention  to 
uterine  functions.  Horse  exercise.  Seabathing.  Shower  baths.  Nour- 
ishintr  food. 


84  COUP    DE    SOLEIL — COAV-POX. 

COUP  DE  SOLEIL. — S^'-non.  Sunstroke;  Insolatio ;  Heat  Apoplexy; 
Eretlilsnius  Tropicus. — A  disease  allied  to  simple  apoplexy.  In  perfect 
form,  only  met  with  in  the  tropics.  Often  fatal  to  European  soldier, 
at  seasons  when  heat  is  very  oppressive. 

Symptoms.  .  Generally,  faintness;  thirst;  considerable  heat  and  dry- 
ness of  skin  ;  great  failure  of  nervous  energy.  Often,  vertigo  and  a  sense 
of  tightness  across  chest.  Pulse  sometimes  quick  and  full,  sometimes  so 
thin  and  feeble  it  can  hardly  be  felt.  As  ease  progresses,  heart's  action 
becomes  violent ;  patient  can  scarcely  be  roused  ;  face  gets  pallid  ;  per- 
haps an  attack  of  vomiting  ushers  in  deep  coma.  While  comatose, 
there  is  heat  of  skin;  dyspnoea;  contracted  pupils,  with  congested  con- 
junctivse;  action  of  heart  intermittent.  Just  prior  to  death,  dilatation 
of  pupils;  gasping  respiration;  perhaps  vomiting. 

In  some  instances,  symptoms  very  insidious.  Mere  listlessness  and 
stupidity;  head  is  said  to  feel  a  little  queer.  Yet  in  twelve  hours, 
death. — Often,  after  exposure  to  sun,  the  individual  has  suddenly  fallen 
down  insensible  ;  made  one  or  two  gasps;  and  died  in  state  of  sj-ncope. 

If  recovery  take  place,  convalescence  apt  to  be  retarded  by  deranged 
secretions,  continued  fever,  some  pulmonary"  complication,  partial  par- 
alysis, or  great  prostration. — Patient  not  free  from  immediate  danger 
until  skin  gets  cool  and  moist.  Many  months  after  apparent  cure, 
symptoms  of  paralysis  or  of  insanity  may  be  developed :  in  an}^  case, 
the  individual  is  seldom  the  man  he  was  prior  to  attack. 

Treatment.  Curative:  Mortality  very  large  where  bloodletting  has 
been  resorted  to.  Most  reliable  remedies, — Cold  to  the  head,  and  stim- 
ulants. A  continuous  stream  of  cold  water  to  be  poured  over  head  and 
neck  and  spine  and  chest,  provided  pulse  be  not  ver}^  weak  and  skin 
cold.  Evaporating  lotions  to  scalp.  Blisters,  or  liniment  of  cantharides, 
to  nucha.  Ammonia.  Ether.  Brandy.  Tea,  well  sweetened.  Ipecacu- 
anha emetics,  if  stomach  be  loaded.  Sinapisms  or  turpentine  stupes  to 
extremities.     Stimulant  enemata.     Ice  to  spine.     Frictions  of  surface. 

Prophylactic :  When  a  march  is  undertaken  in  India  during  hot  sea- 
son, weak  and  sickly  to  be  left  behind.  Costume  to  be  suitable  to  early 
morning  hours  before  sunrise,  as  well  as  for  scorching  heat  which  fol- 
lows. Flannel  shirts,  as  safeguards  against  sudden  chills:  flannel  belts 
advantageous,  save  in  hottest  weather.  Shirt  collars  to  be  open.  Light 
knapsacks,  without  cross-belts  over  chest.  Troops  to  march  easy :  halts 
when  men  are  exhausted,  with  longer  halt  half-way,  so  that  each  man 
may  have  coff'ee  and  biscuit.  To  arrive  on  new  gi'ound  about  an  hour 
after  sunrise.  Camp  to  be  formed  on  as  high  and  open  ground  as  possi- 
ble. Men  to  have  an  ample  supply  of  water.  Rations  of  spirits  to  be 
discontinued  (Aitken). 

COW-POX. — Synon.  Vaccinia. — The  comparative  immunity  against 
small-pox,  conferred  by  vaccination,  was  discovered  by  Jenner  towards 
close  of  eighteenth  century. 

When  vaccination  has  been  successfully  performed  on  healthy  child, 
an  elevation  may  be  felt  over  puncture  on  second  day,  accompanied 
bj'  slight  redness;  on  fifth,  a  distinct  vesicle  is  formed,  having  an  ele- 
vated edge  and  depres.sed  centre;  on  eighth,  it  is  of  a  pearl  color,  and 
is  distended  with  a  clear  lymph.  An  inflamed  areola  now  forms  round 
base  of  little  tumor,  and  increases  during  two  succeeding  days ;  about 
eleventh  day  it  fades ;  and  the  vesicle,  which  has  then  burst  and  ac- 
quired a  brown  color,  gradually  dries  up,  until  by  end  of  second  w^eek 
it  has  become  converted  into  a  hai'd  and  round  scab.  This  falls  off" 
about  twenty-first  day;  leaving  a  circular,  depressed,  striated  cicatrix, 
which  is  2)ermanent  in  after-lfe.     First  vaccination  affords  protection 


CRETINISM — CROUP.  85 

for  ten  years,  perhaps  for  longer :  a  safe  proceeding  to  revaceinate  after 
this  lapse  of  time. 

Four  or  five  separate,  good-sized  vesicles  should  be  pi-oduced. — When 
variola  occurs  after  vaccination,  it  is  known  as  varioloid,  or  modified 
small-pox. 

CRETINISM. — Perhaps,  according  to  Dr.  Mayne,  from  Cretira,  old 
Italian  for  a  poor  creature.  Synon.  Idiotismns  Endeinicus ;  Fatuitas ; 
Alpicolarum ;  Micrencephcdon. — A  form  of  idiocy  accompanied  by  de- 
formity of  the  bodily  organs.  Supposed  by  some  autborities  to  have  a 
close  but  ill-understood  connection  with  goitre. 

Symptoms.  Diminutive  stature.  Large  bead,  flattened  at  top,  and 
spread  out  laterally.  Countenance  vacant  and  devoid  of  intelligence. 
Mouth  gaping  and  slavering.  Tongue  protruding.  Goitre.  Disgust- 
ing habits.     Perhaps  squinting,  deaf-mutism,  blindness. 

Treatment.  Pure  mountain  air.  Plent}^  of  exercise.  Simple  nour- 
ishing food,  with  milk.  Cod-liver  oil.  Carbonate  of  iron.  Phosphate 
of  lime.  Chemical  food.  Valerianate  of  zinc.  Moral  control.  Judici- 
ous mental  training. 

CROUP. — Synon.  Tracheitis;  Cynanche  Traehealis;  Angina  Trachealis. 
An  inflammatory  disease  of  mucous  lining  of  trachea,  or  often  of  glottis 
and  larynx  and  trachea.  Fever  and  inflammation  accompanied  b}'  ex- 
udation of  false  membranes  on  affected  surfaces. — Most  common  during 
second  and  third  years  of  childhood.  Often  complicated  with  bron- 
chitis or  pneumonia.  May  end  fatally  from  exhaustion,  suftbcation, 
convulsions,  or  thrombosis.     Mortality  very  large. — See  Death  Causes. 

Symptoms.  In  early  stage,  those  of  catarrh.  Slight  fever;  cough; 
hoarseness;  drowsiness;  suffusion  of  eyes,  and  running  at  nose.  In 
course  of  eighteen  hours,  wheezing  respiration  ;  fits  of  hoarse  coughing ; 
occasional  spasms  of  laryngeal  muscles.  Then,  characteristic  symptoms : 
alteration  in  cough,  which  is  attended  with  a  peculiar  ringing  sound, 
rendering  it  "brassy."  Inspirations  prolonged;  accompanied  with 
crowing  or  piping  noise.  Eedness  and  swelling  of  tonsils  and  uvula,  less 
marked  than  in  tonsillitis.  Increased  fever.  Breathing  becomes  more 
hurried  and  impeded.  Cough  frequent.  Depression,  with  weakness  and 
irregularity  of  pulse.  Thirst.  Irritability  and  restlessness.  Features 
expressive  of  alarm  and  distress:  patient  grasps  at  his  neck,  or  thrusts 
his  fingers  into  mouth,  as  if  to  remove  cause  of  suffering.  Nocturnal 
exacerbations:  remissions  towards  morning. — As  disease  subsides,  cough 
loses  peculiar  twang,  becomes  moist ;  crowing  inspirations  lessen,  or 
cease. — \yhen  tending  to  death,  drowsiness  gets  extreme,  though  sleep 
is  uneasy;  child  starts,  and  wakes  in  terror.  Breathing  becomes  gasp- 
ing and  interrupted:  suftbcation  seems  imminent.  Congestion  of  lungs. 
Skin  cold ;  covered  with  clammy  sweat.  Perhaps  death  directly  after 
an  inspiration :  asphyxia,  coma,  convulsions,  or  fatal  dyspnoea  from 
thrombosis. 

Treatment.  Under  use  of  bleeding,  tartarated  antimony,  and  mer- 
cmy,  half  the  cases  attacked  die.  For  this  cause  alone,  a  difi'erent  plan 
ought  to  be  tried.     Blisters  most  injurious. 

Confinement  to  bed.  Flannel  clothing.  Temperature  of  room  70° 
F. ;  air  to  be  moistened  with  steam.  Continuous  fomentations  to  throat : 
sponges  dipped  in  water  as  hot  as  can  be  borne.  Emetic  of  ipecacuan,  231. 
Calomel  as  a  purgative,  or  castor  oil,  if  there  be  constipation.  Lessen 
excessive  heat  of  skin  by  warm  bath,  137.  If  skin  be  drj-,  wrap  patient 
in  a  blanket  wrung  out  of  warm  water,  and  cover  all  with  two  or  three 
diy  blankets,  136.  Painting  of  throat  with  belladonna, — diluted  ex- 
tract, liniment,  or  tincture — if  distress  arise  chiefly  from  spasmodic 
contractions  of  laryngeal  muscles.    Iodide  of  potassium  with  assafoetida 


86  CYANOSIS — DEAFNESS. 

and  senega,  81.  Ammonia  and  senega,  235.  Inhalation  of  spray  of  hot 
saccharated  solution  of  lime,  262.  Inhalation  of  oxygen  gas.  Beef  tea. 
Lime-water  and  milk.  Cream.  Wine,  or  brand3\  —  Tracheotomy,  if 
predominant  symptoms  are  those  of  asphyxia  :  inhalation  of  chloroform, 
80  that  operation  may  be  performed  deliberately  and  cautiously.  Atter 
operation,  trust  to  warm  moist  air,  nourishment,  and  stimulants :  aban- 
don medicines. 

Remedies  often  recommended :  Leeches.  Bleeding.  Purging.  Blisters. 
Tartarated  antimony.  Calomel.  Mercurial  inunction.  Digitalis.  Hy- 
drocyanic acid.  vSquills.  Yeratrum  viride.  Sanguinaria  Canadensis. 
Quinine.  Sulphate  of  copper.  Sulphurated  potash.  Nitrate  of  silver, 
locally.  Glycerine,  locally.  Tincture  of  iodine,  painted  over  outside  of 
neck. 

CYANOSIS. — From  /iwavoc,  blue;  k5(toc,  disease.  Synon.  Hamiatocy- 
anosis ;  Morbus  Cceraleus;  Blue  Disease. — A  condition  characterized  by 
a  blue  or  purplish  discoloration  of  skin  ;  arising  generally  in  connection 
with  some  deficiency  in  construction  of  the  heart. 

Chief  mnlformations :  Permanence  of  foramen  ovale,  allowing  a  pas- 
sage of  blood  between  the  auricles.  Abnormal  apertures  in  some  part 
of  sejitum  of  auricles  or  ventricles.  Origin  of  aorta  and  pulmonary 
arteiy  from  a  single  ventricle.  Transposition  of  origins  of  large  vessels 
from  heart;  aorta  arising  from  right,  and  pulmonary  artery  from  left, 
ventricle.  An  extreme  contraction  of  pulmonary  artery.  Continued 
patescence  of  ductus  arteriosus,  jDermitting  a  mixture  of  bloods  of  aorta 
and  pulmonary  artery. 

Symptoms.  Discoloration  of  skin.  Coldness  of  body:  temperature 
of  mouth  sometimes  reduced  to  77°  F.  Palpitation.  Fits  of  dyspnoea. 
vSyncope  on  excitement.  Tips  of  fingers  and  toes  become  bulbous:  nails 
incurvated.  Generative  organs  often  imperfectly  developed.  Conges- 
tion of  internal  organs,  and  dropsical  effusions. — Infants  affected,  gen- 
erally die  very  early:  occasionally,  life  prolonged  to  adult  age.  Males 
more  prone  to  cyanosis  than  females.  Under  exceptional  circumstances 
it  may  not  come  on  until  somewhat  late  in  life. 

Treatment.  Must  be  simplj-  palliative.  Nourishing  food.  Occa- 
sionally, mild  tonics.  Warm  clothing.  Avoidance  of  fatigue,  or  mental 
excitement.     Residence  in  pure  mild  air. 

CYNANCHE  LARYNGEA.— From  /lucyv,  a  dog;  «>/«»,  to  strangle,— 
because  dogs  were  sii]»]>osed  to  be  especially  liable  to  sore  throat:  Adpuyq, 
the  windpipe.  Synon.  Angina  Laryngea  ;  Inflammation  of  the  Larynx. — 
See  Laryngitis. 

CYNANCHE  PAROTIDEA.— From  Kuwv,  a  dog;  «V;^a>,  to  strangle: 
Udpa,  ne'dv;  oS?,  the  ear.  Sj-non.  Parotitis  Contagiosa ;  Angina  Externa ; 
Mnmjys ;  Branks ;  hiflammatio7i  of  the  Parotid  Gland. — See  Parotitis. 

CYNANCHE  TONSILLARIS.— From  Kbojv,  a  dog;  ^yxio,  to  strangle: 
TonsiUa,  the  tonsil.  S^-non.  Amygdalitis ;  Angina  Tonsillaris;  Liflam- 
matory  Sore  Throat;  Quinsy. — See  Tonsillitis. 

CYNANCHE  TRACHEALIS.— From  A'uw,,  a  dog;  cly/ju,  to  strangle: 
TracJiea,  the  windpipe.  Synon.  Suffocatio  Stridxila ;  Angina  Membrana- 
cea ;  Laryngotracheitis  ;  Mising  of  the  Lights  ;  Inflammation  of  the  Trachea. 
— See  Croup. 

DEAFNESS. — Synon.  Cophosis  ;  Surditas ;  Hardness  of  Hearing — May 
be  the  result  of  rheumatism,  gout,  or  some  diminution  of  nervous  force. — 
See  also,  O^orr/tci'rt ;  Otitis;  Eustachian  tube. 


DEATH    CAUSES.  87 

1.  Rheumatism  of  Ear. — Most  frequently  occurs  after  subsidence  of 
rheumatic  inflammation  of  joints. 

Symptoms.  Tenderness  of  scalp,  temple,  mastoid  process,  jaw,  and 
teeth  on  affected  side.  Distressing  tinnitus.  Nightly  exacerbations, 
with  acid  perspirations.  An  acute  attack  may  prove  most  destructive 
by  producing  periosteal  inflammation  and  caries  Sometimes  obstinate 
otorrhoea  results:  may  lead  to  exfoliation  of  a  portion  of  bone. 

Treatment.  Alkaline  salts.  Iodide  of  potassium.  Opium.  Hot 
bathing.  Fomentations.  When  great  tenderness  exists  over  mastoid 
process,  much  relief  may  be  given  by  an  incision  over  this  part  down 
to  the  bone,  so  as  to  free  tense  inflamed  periosteum. 

2.  Gout  of  Ear. — A  common  cause  of  deafness.  Ear  seldom  attacked 
until  small  joints  have  been  frequently  invaded.  Deafness  generally 
preceded  by  severe  headaches. 

Symptoms.  Gout  affecting  eocternal  ear  often  sets  in  soon  after  mid- 
night. Tearing  or  twisting  pain  ;  burning  heat ;  beating  noises  or  sing- 
ing in  ear;  swelling  with  redness. — Minute  articulations  of  bones  in  the 
middle  ear  may  sufter.  Pain  very  acute.  Sometimes  loss  of  conscious- 
ness, delirium,  or  convulsions.  Concretions  and  deposits  of  urate  of 
soda  found  after  death  (Harvey). 

Treatment.  Same  as  for  gout  in  other  parts  of  body.  Purging  with 
neutral  salts.  Alkalies.  Colchicum.  Fomentations.  When  apparently 
due  to  metastasis,  mustard  pediluvia,  or  other  local  stimulants,  to  recall 
disease  to  less  important  joints. 

3.  Nervous  Deafness. — Somewhat  analogous  to  amaui-osis.  More  or 
less  deafness  owing  to  some  lesion  of  nervous  system;  whether  the  mis- 
chief have  its  seat  in  nervous  tissue  expanded  in  labyrinth,  at  origin  or 
in  course  of  seventh  pair,  or 'in  brain  itself. — In  some  cases  no  relief  can 
be  given;  as  in  senile  deafness,  arising  from  insensibility  of  nervous 
tissue  due  to  old  age.  Ear-trumpets.  Marshall's  Double  Reflecting 
Ear-trumpets  possess  great  advantages  as  regards  the  ease  and  distinct- 
ness with  which  they  convey  sounds  of  voice,  without  any  necessity  for 
speaker  doing  more  than  articulate  clearly.  Singing  noises  and  deaf- 
ness sometimes  due  to  decayed  teeth. 

DEATH  CAUSES. — Life  can  only  be  maintained  by  the  circulation  of 
arterial  blood.  If  no  blood  circulates  through  arteries,  or  only  venous 
blood,  the  result  is  death.  When  no  blood  circuhites,  death  due  to  syn- 
cope (luyxoTTTuj,  to  be  affected  with  sudden  prostration  of  strength),  which 
is  of  two  kinds:  (1)  Death  by  ancemia  ('J,  priv. ;  aifj-a,  blood),  in  which 
there  is  a  want  of  due  suj)ply  of  blood  to  heart;  as  in  fatal  hemorrhage. 
(2)  Death  by  asthenia  ('J,  priv.;  ffdivu^,  strength),  where  there  is  a  failure 
in  contractile  power  of  heart;  as  in  apoplexy,  action  of  certain  poisons, 
&c. — Sometimes  life  fails  p art h' from  anaemia  and  partly  from  asthenia; 
as  in  cases  of  starvation,  phthisis,  dysentery,  &c. 

If  venous  blood  circulate  through  arteries,  death  happens  in  one  of 
two  ways:  (1)  Jiy  ajiJicea  ('A,  priv.;  micu,  to  breathe),  asphyxia,  or  suffo- 
cation, where  access  of  air  to  lungs  is  stopped;  as  in  drowning,  strangu- 
lation, many  laryngeal  and  lung  diseases,  tetanus,  section  of  phrenic 
and  intercostal  nerves,  &c.  (2)  By  coma  (Kw/ia,  deep  sleep),  in  which 
muscular  movements  required  for  respiration  cease  owing  to  insensi- 
bilit}'  produced  by  cerebral  disease. — In  apncea  there  ai^e  successively 
impeded  respii'ation,  circulation  of  venous  blood,  and  insensibility.  In 
coma  the  order  is  reversed, — insensibilit}^  cessation  of  thoracic  move- 
ments, and  stoppage  of  chemical  functions  of  lungs. 

The  following  table  shows  the  Causes  of  Death  in  England  for  the 
four  years  186U-1863,  as  well  as  the  classification  ado^ited  by  the  Regis- 
trar-General : 


88 


DEATH   CAUSES. 


1860 

1861 

1862 

1863 

Estimated  Population  of  England  in 
middle  of  the  Years,      .... 

19,902,713 

20,119,314 

20,336,467 

20,554,137 

CO 

DISEASES. 

1860 

1861 

1862 

1863 

ALL  CAUSES, 

422,721 

435,114 

436,566 

473,837 

(Classes.) 

I. 

ZYMOTIC    DISEASES,   .     . 

75,849 

87,986 

91,539 

119,731 

11. 

co:nstitutional  "    .    . 

82,088 

84,987 

83,024 

84,393 

111. 

LOCAL                            "     .     . 

171,037 

167,454 

170,651 

174,6(i3 

IV. 

DEVELOPMENTAL"     .     . 

70,311 

71,948 

68,842 

71,467 

V. 

VIOLENT  DEATHS,  .     .     . 
SuBDEN  Deaths,  Cause  un- 

14,775 

14,985 

14,944 

15,680 

I. 

ascertained,     

2,894 

2,697 

2,778 

3,008 

(Orders.) 

1.  Miasmatic  Diseases,     .     . 

71,304 

83,324 

86,881 

114,538 

2.  Enthetic 

1,252 

1,355 

1,449 

1,578 

3.  DiETIC, 

2,206 

2,095 

2,149 

2.456 

II. 

4.  Parasitic, 

1.  Diathetic, 

1,087 

1,212 

1,060 

1,159 

16,404 

16,233 

16,412 

16,651 

III. 

2.  Tubercular, 

Diseases  of — 

65,684 

68,754 

66,612 

67,742 

1.  Nervous  System,  .     .     . 

55,577 

55,625 

55,692 

57,428 

2.  Organs  of  Circulation, 

18,758 

18,076 

18,709 

19,505 

3.  Eespiratory  Organs, 

68,408 

64,310 

67,565 

67,280 

4.  Digestive  Organs,     .     . 

19,718 

20,327 

19,421 

20,516 

5.  Urinary  Organs,  .     .     . 

4,990 

5,222 

5,328 

5,578 

6.  Organs  of  Generation, 

1,118 

1,129 

1,227 

1,219 

7.  Organs  of  Locomotion,  . 

1,466 

1,624 

1,588 

1,765 

IV. 

8.  Integumentary  System, 
1.  Dev.    Diseases    of   Chil- 

1,002 

1,141 

1,121 

1,312 

dren,    .... 

12,706 

13,116 

12,787 

13,498 

2.            "     Adults,  .... 

2,233 

2,168 

2,198 

2,508 

3.            "     Old  People,     .     . 

28,442 

27,373 

26,780 

27,268 

4.  Dis.  OF  Nutrition,   .     .     . 
1.  Accident  or  Negligence, 

26,930 

29,291 

27,077 

28,193 

12,991 

13,187 

13,055 

13,772 

2.  Battle, 

* 

* 

* 

* 

3.  Homicide, 

377 

320 

418 

399 

4.  Suicide, 

1,365 

1,347 

1,317 

1,319 

5.  Execution, 

10 

11 

17 

21 

V. 

Other  Violent  Deaths  not 

I. 

CLASSED,     

32 

120 

137 

169 

Order  1. 

1.  Small-pox, 

2,749 

1,320 

1,628 

5,964 

2.  Measles, 

9,557 

9,055 

9,800 

11,349 

3.  Scarlatina, 

9,681 

9,077 

14,834 

30,475 

4.  Diphtheria, 

5,212 

4,517 

4,903 

6,507 

6.  Quinsy, 

319 

342 

323 

334 

6.  Croup, 

4,380 

4,397 

5,667 

6,957 

7.  Whooping-cough,       .     .     . 

8,555 

12,309 

12,272 

11,275 

8.  Typhus  (and  infantile  fever). 

13,012 

15,440 

18,721 

18,017 

DEATH    CAUSES. 


89 


05 

CS 

0 

DISEASES. 

18G0 

1861 

1862 

1863 

I. 

Order  1 — continued. 

9.  Erysipelas, 

1,06.5 

1,542 

1,.523 

1,920 

10.  Mcti-ia,     . 

987 

886 

940 

1,155 

11.  CiirbuMcle, 

247 

193 

206 

237 

12.  Influenza, 

1,130 

746 

915 

919 

18.  Dysentery, 

1,156 

1,416 

1,044 

1,051 

14.  Diarrhcea, 

9,702 

18,746 

11,112 

14,943 

15.  Cholera,  . 

327 

837 

511 

807 

16.  As^ue, .     . 

203 

149 

150 

141 

17.  Remittent  Fever, 

314 

254 

284 

198 

18.  Kheumatism,     . 

1,998 

1,982 

1,943 

2,175 

19.  Other  Zymotic  Diseases, 

110 

116 

105 

114 

Order  2. 

1.  Syphilis, 

1.067 

1,177 

1,245 

1,386 

2.  Stricture  of  Urethra,  .     .     . 

178 

168 

199 

183 

3.  Hydrophobia, 

3 

4 

1 

4 

4.  Glanders, 

Order  3. 

4 

6 

4 

5 

1.  Privation, 

68 

63 

73 

54 

2.  Want  of  Breast-milk,      .     . 

1,002 

970 

1,006 

1,158 

3.  Purpura  and  Scurvy,  . 

361 

405 

353 

409 

.     . ,     ,    ,     f  rt  Delirium  Trem., 
4- ^^^"^^°1' 16  Intemperance,. 

Order  4. 

457 

415 

471 

471 

318 

242 

246 

364 

1.  Thrush, 

920 

1,055 

904 

961 

II. 

2.  Worms,  &c., 

Order  1. 

167 

157 

156 

198 

1.  Gout,     . 

268 

247 

284 

248 

2.  Dropsy, 

7,823 

7,301 

7,247 

7,414 

3.  Cancer, 

6,827 

7,276 

7,396 

7,479 

4.  Noma, 

122 

174 

197 

180 

5.  Mortification, 

Order  2. 

1,364 

1,235 

1,288 

1,330 

1.  Scrofula, 

2,995 

3,457 

3,416 

3,277 

2.  Tabes  Mesenterica,      .     .     . 

4,982 

5,692 

5,203 

5,877 

3.  Phthisis, 

50,149 

51,931 

50,962 

51,072 

III. 

4.  Hydrocephalus, 

Order  1. 

7,229 

7,674 

7,031 

7,516 

1.  Cephalitis, 

3,518 

3,426 

3,580 

3,869 

2.  Apoplexy, 

9,181 

8,795 

9,136 

9,721 

3.  Paralysis, 

9,752 

9,812 

9,733 

9,762 

4.  Insanity, 

536 

529 

535 

555 

5.  Chorea 

66 

71 

52 

63 

6.  Epilepsy, 

2,454 

2,464 

2,443 

2,574 

7.  Convulsions, 

25,205 

25,423 

25,286 

26,008 

8.  Brahi  Disease,  Jfc,  .... 
Order  2. 

4,865 

5,105 

4,927 

4,876 

1.  Pericarditis, 

575 

541 

559 

597 

2.  Aneurism, 

368 

387 

373 

418 

3.  Heart  Disease,  <J-c.,  .     ,     .     . 
Order  3. 

17,815 

17,148 

G 

17,777 

18,490 

1.  Laryn2;itis, 

1,166 

1,253 

1,478 

1,561 

2.  Bronchitis, 

32,347 

30,986 

32,526 

32,025 

3.  Pleurisy, 

882 

781 

833 

907 

4.  Pneumonia, 

25,264 

22,914 

23,713 

24,181 

90 


DEATH    CAUSES. 


DISEASES. 

1860 

1861 

1862 

1863 

III. 

Order  3 — continued. 

5.  Asthma, 

4,325 

3,892 

4,087 

3,699 

6.  Lung  Disease,  ^c,  .... 
Order  4. 

4,424 

4,484 

4,928 

4,907 

1.  Gastritis, 

704 

809 

765 

838 

2.  Enteritis, 

3,154 

3,333 

2,911 

3,234 

3.  Peritonitis, 

1,151 

1,563 

1,488 

1,637 

4.  Ascites 

750 

728 

745 

735 

5.  Ulceration  of  Intestine,      . 

847 

856 

870 

858 

6   Hernia, 

817 

852 

827 

848 

7.  Ileus, 

1,170 

1,199 

1,091 

1,166 

8.  Intussusception,     .... 

245 

276 

280 

246 

9.  Stricture  of  Intestine,    .     . 

301 

272 

257 

288 

10.  Fistula, 

115 

115 

109 

89 

11.  Stomach  Disease,  ^-c, 

2,866 

2,786 

2,730 

2,  SCO 

12.  Pancreas  Disease,  ^c,     .     . 

12 

18 

16 

12 

13.  Hepatitis, 

1,329 

1,386 

1,262 

1,4U2 

14.  Jaundice, 

1,262 

1,344 

1,292 

1,426 

15.  Liver  Disease,  i^c,       .     .     . 

4,531 

4,704 

4,680 

4,853 

16.  Spleen  Disease,  ^-c,    .     .     . 
Order  5. 

64 

86 

98 

84 

1.  Nephritis, 

245 

306 

273 

385 

2.  Ischuria, 

96 

102 

104 

143 

3.  Nephria, 

1,390 

1,448 

1,541 

1,700 

4.  Diabetes, 

536 

637 

574 

551 

5.  Stone 

179 

168 

196 

172 

6.  Cvstitis 

299 

343 

342 

340 

7.  Kidney  Disease,  ^-c. ,     .     .     . 

2,245 

2.318 

2,298 

2,337 

1.  Ovarian  Dropsv,      .... 

244 

235 

280 

255 

2.  Uterus,  ^-c,  Disease,    .     .     . 
Order  7. 

874 

894 

947 

964 

1.  Arthritis, 

68 

79 

70 

73 

2.  Joint  Disease,  S^-c,   .     .     .     . 
Order  8. 

1,398 

1,545 

1,518 

1,692 

1.  Phlcs;mon, 

413 

454 

409 

530 

2.  Ulcer 

332 

401 

387 

435 

IV. 

3.  Skin  Disease,  cf-r.,     .     •     .     . 
Order  1, 

257 

286 

325 

347 

1.  Premature  Birth,    .... 

7,642 

7,610 

7,706 

8,121 

2.  Cvanosis 

398 

420 

4.59 

456 

3.  Spina  Bifida,       .     . 

350 

394 

386 

402 

4.  Other  Malformations,       .     . 

420 

441 

424 

403 

5.  Teething, 

Order  2. 

3,896 

4,251 

3,812 

4,116 

1.  Paramenia, 

47 

59 

61 

75 

2.  Childbirth  {see  Metria),   .     . 
Order  3. 

2,186 

2,109 

2,137 

2,433 

1.  Old  Age,    ....... 

Order  4. 

28,442 

27,373 

26,780 

27,268 

V. 

1.  Atrophy  and  Debility,     .     . 
Order  1. 

26,930 

29,291 

27,077 

28,193 

(Accident  or  Negligence.) 

1.  Fractures  and  Contusions,    . 

5,417 

5,589 

5,397 

5,852 

103 

120 

111 

108     ; 

DELIRIUM    TREMENS. 


91 


C3 
5 

DISEASES. 

1860 

1861 

1862 

1863 

V. 

Order  1 — continued. 

3.  Cut,  Stab, 

4.  Burns  and  Scalds,  .... 

5.  Poison, 

6.  Drowning, 

7.  Sufl'ocation, 

8.  Otherwise, 

Order  3. 

(Homicide.) 
1.  Murder  and  Manslaughter,  . 

Order  4. 

(SOICIDE.) 

1.  Gunshot  Wounds,  .... 

2.  Cut,  Stab, 

3.  Poison, 

4.  Drowning, 

5.  Hanging, 

6.  Otherwise, 

Order  5. 

(Execution.) 

1.  Hanging, 

Other     Violent    Deaths     (not 
classed), 

Sudden  and  other  Deaths  (Cause 
unascertained), 

81 
3,166 

240 
2,264 
1,061 

6-59 

41 
3,053 

258 
2,351 
1,014 

761 

54 

2,767 

262 

2,463 

1,219 

782 

82 
2,766 
277 
2,488 
1,147 
1,052 

377 

320 

418 

399 

59 
276 
156 
219 
569 

86 

59 
257 
122 
225 
592 

92 

54 
215 
128 
204 
611 
105 

56 
257 
121 
245 
562 

78 

10 

11 

17 

21 

32 

120 

137 

169 

8,661 

7,754 

7,566 

7,963 

DELIRIUM  TREMENS. — From  Deliro,  to  be  crazy :  Tremo,  to  tremble. 
Syiion.  Delirium  Ehriositaiis ;  Mania  a  Potu ;  Delirium  Vigilans.  —  An 
acute  attack  of  poisoning  by  alcoholic  drinks.  Delirium  characterized 
by  hallucinations,  fear,  trembling  of  muscles  of  extremities,  weakness, 
and  watchfulness.  Natural  tendency  of  the  disorder  to  terminate  in  a 
critical  sleep,  at  end  of  from  forty-eight  to  seventy-two  hours  from  com- 
mencement of  delirium. 

Symptoms.  Sleeplessness.  Loss  of  appetite.  Xausea.  Constipation. 
A  busy,  but  not  violent,  delirium  :  aggravated  towards  night.  Constant 
talking  or  muttering.  Tremulous  motions  of  hands:  constant  twitch- 
ing ot^  facial  muscles.  Hallucinations  of  sight  and  hearing.  A  dread 
or  suspicion  of  every  one:  a  belief  that  strangers  are  under  the  bed,  or 
listening  at  door  Mental  with  bodil}^  prostration.  A  generally  excited 
and  eager  manner.  In  severe  cases,  an  increase  in  sulphates  and  urea, 
with  diminution  of  phosphates,  in  urine.  Varies  thus  from  phrenitis, 
in  which  phosphates  are  in  excess. 

1\\  favorable  cases,  critical  sleep,  lasting  f-welve  or  more  hours;  from 
which  patient  wakes  cured,  though  weak,  lu  fatal  examples,  watchful- 
ness continues;  muttering  delirium,  subsultus  tendinum,  and  exhaus- 
tion ;  great  prostration,  coma  or  convulsions  or  fatal  syncope.  Death 
usually  between  third  and  seventh  daj^s. 

Treatment.  Critical  sleep  to  be  brought  about  as  soon  as  possible. 
Ice  to  cool  irritable  stomach.  Salines,  348,  349,  350.  Milk,  raw  eggs, 
beef  tea.  Brand}-  and  egg  mixture,  17.  Ammonia  and  bitters,  361, 
371.  Ether,  brandy,  and  bark,  367.  Sumbul  and  hop,  369.  Morphia, 
chloroform,  and  Indian  hemp,  317.     Subcutaneous  injection  of  morphia, 


92  DENGUE — DIABETES    MELLITUS. 

314.  Tincture  of  digitalis,  in  half  ounce  doses,  once  or  twice  repeated. 
Patient  to  be  restrained  by  one  or  two  good  attendants.  Apartment  to 
be  kept  quiet  and  dark.  All  soui-ces  of  mental  irritation  to  be  removed. 
Cold  atfiifsion,  or  cold  shower  bath,  sometimes  very  useful. 

Avoidance  of  over-stimulation,  and  excessive  doses  of  opium.  Use  of 
strait-waistcoat  very  rarely  advisable,  as  it  increases  irritation. — See 
Dipsomania. 

DENGUE. — Synon.  Scarlatina  Bheumatica;  Ervptive  Epidemic  Fever ; 
Eruptive  Rheumatic  Fever ;  Dandy  Fever ;  Break-hone  Fever. — In  certain 
parts  of  East  Indies,  Southern  States  of  America,  as  well  as  in  Phila- 
delphia and  New  York,  a  peculiar  infectious  fever  sometimes  prevails, 
in  which  an  eruption  like  that  of  scarlatina  is  combined  with  severe 
rheumatic  pains  in  limbs  and  joints.  Sometimes,  throat  is  implicated; 
occasionally,  testicles  enlarge ;  often,  lymphatic  glands  of  neck  and 
groin  swell.  Pains  about  shoulders  and  arms,  loins  and  hips,  thighs  and 
legs;  great  soreness  of  muscles  and  bones;  headache  and  flusiiing  of 
face;  rapid  pulse  and  coated  tongue ;  nausea  and  vomiting;  prostration. 
The  disease  generally  lasts  about  eiglit  days.  Demands  the  use  of 
antacid  aperients,  saHnes,  colchicum  with  opium,  and  bark  or  quinine. 

DIABETES  MELLITUS.— From  Ain,  through;  /SatVw,  to  move:  MiXi, 
honey.  Synon.  Melituria;  Paruria  Mellita ;  Glucosuria ;  Glucolumrua ; 
Saccharine  Diabetes. — A  complicated  chronic  disease,  due  to  inefficient 
performance  of  some  important  function.  Characterized  by  secretion 
of  a  large  quantity  of  urine  containing  glucose  or  grape  sugar. 

Symptoms.  Come  on  insidious!}'.  Malaise:  sense  of  feverishness. 
Excretion  of  large  quantities  of  ui'ine,  having  a  faint  ajiple-like  odor, 
and  a  high  sp.  grav.  1035 — 1050.  Dryness  and  harshness  of  skin.  Con- 
stipation :  hard  dry  fseces.  Constant  thirst.  Failure  of  general  health  : 
muscular  weakness;  loss  of  sexual  power.  Pain  about  loins.  Coldness 
of  extremities,  with  sense  of  burning  in  hands  and  feet.  Increasing  de- 
bility, diminution  in  weight,  shrinking  of  frame,  oedema  of  legs,  and 
sometimes  albuminuria.  Chloroform-like  smell  of  breath.  Sponginess 
of  gums,  with  decay  of  teeth.  Mental  depression  and  irritability.  Con- 
stant sense  of  sinking  at  stomach,  with  voracious  appetite.  Tendency 
to  double  cataract:  to  boils. — Often  becomes  associated  with  phthisis 
after  a  time.  In  confirmed  cases,  death  from  some  intercurrent  low 
form  of  inflammation — bronchitis,  pleurisy,  pneumonia,  or  peritonitis; 
from  gangrene  of  legs;  phthisis;  or  from  gradual  exhaustion. 

Sugar  to  be  detected  in  urine  by  fungus,  potash,  copper,  or  fermenta- 
tion tests. 

Treatment.  Diet:  To  be  nutritious,  yet  free  from  saccharine  and 
am^-laceous  materials.  Meat,  ])Oultry,  game,  ham  or  bacon,  white  fish, 
eggs.  Milk,  or  preferably  cream.  Neufchatel,  Stilton,  or  cream  cheese. 
Butter.  Greens,  green  leaves  of  lettuce,  spinach,  watercresses.  Bran 
loaf,  9.  Almond  rusks  and  biscuits.  Gluten  bread.  Stale,  well-fer- 
mented bread  thoroughly  toasted.  Spring  water,  iced  M-ater,  soda 
water,  Vichy  water.  Tea  sweetened  with  glj^cerine.  Weak  beef  tea, 
mutton  broth.  Dry  sherry:  Bordeaux  wine:  dry  Hungarian  wines: 
Burgundy:  weak  brandy  and  water:  whiskey  and  Avater. — Forbid: 
Sugar,  Pastry.  Fruit.  Confectionery.  Potatoes.  Carrots.  Parsnips. 
Beetroot.  Turnips.  Eadishes.  Maccaroni.  Eice,  sago,  tapioca,  arrow- 
root. Liver.  Oysters,  lobsters,  crabs,  mussels.  Beer;  raw  spirits; 
liqueurs.     Coffee. 

Drugs:  Opium  (gr.  I — 1,  thrice  daily).  Opium,  ipecacuan.  and  nitre, 
324.     Citrate  of  ammonia  or  potash,  Avith   steel,  4U3.     Eeduced  iron. 


DIARRHCEA DIPHTHERIA.  93 

aloes,  and  nux  vomica,  404.  Strychnia.  Quinine  and  opium,  Ci'cusote, 
41.  Cod-liver  oil;  or  suet  boiled  in  milk.  Pepsine,  420.  Castor  oil: 
Seidlitz  powders:  Compound  powder  of  rhubarb  and  magnesia:  Aperi- 
ent enemata. 

General  remedies:  Warm  clothing:  flannel  or  chamois  leather  next 
the  skin  of  trunk  and  extremities.  Hot  water  or  vapor  baths.  Turkish 
bath,  130.     Mineral  springs  of  Vichy,  479.     Carlsbad,  496. 

Remedies  which  have  been  employed:  Carbonate  of  soda.  Acetate  of 
potash.  Tartrate  of  potash  and  soda.  Carbonate  of  ammonia.  Alum. 
Lime-water.  Yeast.  Large  quantities  of  sugar.  Potato  bread.  Iodine. 
Nitric  acid.  Phosphoric  acid.  Sulphur.  Tui-peutine.  Permanganate 
of  potash.     Inhalation  of  oxygen  gas. 

DIARRHCEA. — From  Acappiuj,  to  flow  through.  Synon.  Coprorrhoea  ; 
Cafarrhus  Intestinalis ;  Summer  or  Bilious  Diarrhoea;  English  Cholera; 
Purging. — A  relaxed  state  of  bowels,  i.e.  the  frequent  evacuation  of 
loose  or  liquid  stools,  w'ithout  any  coexistent  inflammation  of  intestines. 

Symptoms.  Purging.  Nausea.  Furred  tongue.  Foul  breath.  Flatu- 
lence and  griping  pains.  Acid  eructations.  Tenesmus.  Stools  un- 
healthy: consist  either  of  liquid  fa3ces,  or  a  watery  feculent  mucus,  or 
thin  frothy  serum,  or  of  pale  j-east-like  matter.  In  severe  summer  or 
English  cholera,  evacuations  often  consist  chiefly  of  bile:  violent  ab- 
dominal pains,  cramps  in  legs,  chilliness,  and  depression. 

Treatment.  Expulsion  of  offending  matter  from  intestinal  canal :  Cas- 
tor oil,  164.  Castor  oil  and  opium,  114,  164.  Tincture  of  rhubarb. 
Compound  powder  of  rhubarb.  Blue  pill  and  rhubarb,  171.  Warm 
water  enema.     Calomel. 

Subsequently,  or  at  first  when  cause  has  been  removed  by  spontaneous  purg- 
ing :  Ether  and  opium,  85.  Chloroform,  morphia,  and  Indian  hemp, 
317.  Chalk  mixture,  with  catechu  and  opium,  97.  Rhatany,  96.  Ma- 
tico  and  rhatany,  1U5.  Aromatic  sulphuric  acid  and  opium,  lOJ.  Liquid 
extract  of  bael,  58,  97.  Kino  and  logwood,  108.  Compound  powder  of 
catechu.  Aromatic  powder  of  chalk  and  opium.  Powder  of  kino  and 
opium.  Powxler  of  ipecacuan  and  opium.  White  bismuth,  65,  112.  As- 
tringent enemata,  113.  Enema  of  opium.  Morphia  suppository.  Vege- 
table charcoal,  98. — Careful  diet:  Mucilay;inous  drinks.  Mucilaire  of 
gum  Ai'abic.  Tapioca,  sago,  or  milk  arrowroot.  Saccharated  solution 
of  lime  and  milk,  14.  Custard  or  rice  puddings.  White  fish.  Pepsine, 
420.  Port  wine.  Brandy  and  cold  water.  Ice. — Linseed  poultices. 
Turpentine  stupes.  Wearing  a  flannel  round  abdomen.  Avoidance  of 
damp  and  cold. 

Remedies  sometimes  used :  Niti-ate  of  silvei-.  Chloride  of  silver.  Sul- 
phate of  copper.  Ammonio-sulphate  of  copper.  Tannate  of  bismuth. 
Alum.  Cinnamon.  Oxide  of  zinc.  Iron-alum.  Tincture  of  perchloride 
of  iron.  Acetate  of  lead.  Ergot  of  rye.  Dilute  sulphuric  acid.  Blis- 
ters.    Ice  to  sjjine,  &c. 

DIPHTHERIA. — From  At(pdipa,  a  skin  or  membrane.  Synon.  Angina 
Midigna;  Cynanche  Membranacea  ;  Putrid  Sore  Throat;  Malignant  Quinsy. 
— An  epidemic  and  contagious  sore  throat  of  great  severity,  due  to  tox- 
aemia; being  attended  with  much  prostration,  and  characterized  by  ex- 
udation of  false  membranes  on  tonsils  and  adjacent  structures. — When 
followed  by  recovery,  it  often  leaves  an  altered  state  of  voice,  jjartial 
paralysis  of  muscles  of  deglutition,  weakness  of  upper  extremities,  im- 
paired vision,  and  other  secondary  nerve  affections. — Children  more 
obnoxious  to   this  specific  blood-disease    than  adults.     Most  common 


94  DIPHTHERIA. 

amongst  poor,  or  such  as  reside  in  damp  situations  and  badly  drained 
houses. 

Symptoms.  Commence  gradually;  feelings  of  depression  and  muscu- 
lar debility,  headache,  nausea,  slight  diarrhoea,  chilliness,  drowsiness, 
and  sense  of  stiffness  about  neck.  Then,  tonsils  get  inflamed  and  swol- 
len :  tenderness  of  glands  about  angles  of  lower  jaw.  Inflammatory 
action  spreads  to  velum,  uvula,  posterior  part  of  pharynx.  Perhaps 
difficult  deglutition.  If  resolution  do  not  occur,  characteristic  feature 
becomes  manifested, — effusion  of  a  plastic  fibrinous  material.  This  may 
first  appear  in  nasal  fossse,  or  on  soft  palate,  on  one  tonsil,  or  on  back 
of  pharynx.  Exudation  looks  like  ash-colored  specks;  which,  enhu-ging 
and  coalescing,  form  large  patches  resembling  damp  dirty  wash-leather. 
As  disease  spreads,  false  membrane  increases  in  thickness  and  extent: 
firmly  attached  to  mucous  membrane  beneath:  if  forcibly  removed,  a 
new  patch  soon  forms :  spreads  to  cheek  and  gums,  oesophagus,  or 
through  glottis  into  larynx  and  trachea.  AVhen  membrane  begins  to 
separate  and  decompose,  horribly  fetid  breath  :  when  thrown  oft',  there 
may  be  left  ulceration,  sloughing,  or  gangrene;  or  tissues  gradually  as- 
sume a  healthy  appearance.  True  diphtheritic  membranes  sometimes 
form  on  abraded  cutaneous  surface,  conjunctiva,  mucous  coat  of  vagina 
or  rectum,  &c. 

Constitutional  symptoms  perhaps  slight  at  first.  Soon,  prostration 
and  restlessness.  Only  moderate  fever.  Pulse  increases  in  rapidity. 
Saliva  often  dribbles  away.  Breath  fetid.  Disinclination  for  exertion 
or  food.  Dj^sphagia  often  absent.  Attacks  of  hemorrhage  occasionall}', 
from  nose,  fauces,  or  bronchi.  Purpura.  Albuminuria. — Death  from 
exhaustion,  hemorrhage,  ichorha^mia,  uraemia,  gangrene,  or  asphj'xia, — 
consciousness  remaining  till  close.  Sometimes,  fatal  event  due  to  throm- 
bosis.— In  event  of  recovery,  convalescence  tardy.  Anaemia.  Secondary 
nerve  affections :  paralysis,  neuralgia,  defective  vision. 

Treatment.  No  specific  known.  By  remedies  of  a  supporting  na- 
ture, patient  may  be  often  guided  through  the  great  danger,  which  is 
present  in  every  case. 

Locally:  External  applications — leeches,  blisters,  poultices,  fomenta- 
tions— to  throat,  useless  or  injurious.  At  commencement,  inhalation  of 
acid  vapor — three  ounces  of  vinegar  to  pint  of  boiling  water.  When 
pellicle  has  formed, — spray  of  hot  atomized  lime-water,  262.  Painting, 
with  tincture  of  perchloride  of  iron  and  glycerine;  turpentine;  strong 
solution  of  nitrate  of  silver;  solution  of  chlorinated  soda.  Hydrochloric 
acid  gargle,  2.A9>.  Borax  gargle,  250.  Chlorinated  soda  gargle,  254. 
Creasote  gargle,  255.  Gargle  of  hot  saccharated  solution  of  lime.  Avoid- 
ance of  solid  nitrate  of  silver,  nitric  acid,  hydrochloric  acid,  and  other 
caustics.     Tearing  away  of  exudation,  injurious. 

General  remedies :  In  early  stage,  emetic  of  ipecacuan  and  ammonia, 
233.  Cream  of  tartar  drink,  356.  Chlorate  of  potash  drink,  360.  If 
there  be  depression,  hemorrhage,  or  albuminuria,  commence  with  tinc- 
ture of  perchloride  of  iron,  392.  Quinine  and  iron,  380.  If  thrombosis 
be  feared,  ammonia  and  bark.  371.  Chlorate  of  potash,  61.  Iodide  of 
potassium,  31.  Sulphite  of  soda,  or  magnesia,  48.  Opium.  Essence  of 
beef,  3.  Eggs,  cream,  and  beef  tea,  5.  Lime-water  and  milk,  14.  Brandy 
and  eggs,  17.  Brandy.  Port  wine.  Champagne.  Milk,  or  cream.  Ice, 
to  suck  veiy  freely. 

Patient  to  be  kept  in  bed,  from  commencement ;  flannel  clothing  often 
advantageous.  Air  of  room  to  be  pure  and  warm  (70°  F.);  to  be  kept 
moist  by  evaporation  of  boiling  water.  Sinapisms  to  epigastrium,  if 
there  be  sickness.  Simple  enemata,  or  castor  oil,  if  there  be  constipa- 
tion.    Linseed  poultices  to  loins,  or  hot  fomentations,  if  suj)pression  of 


DIPLOPIA — DRACONTIASIS.  95 

urine  come  on.  Cliloroform  inhalation,  where  attacks  of  dj'spnoea  are 
paroxysmah  Tracheotomy  or  laryngotomy,  when  exudation  obstructs 
larynx.  When  swallowing  is  prevented,  nutrient  enemata,  21,  22,  23. — 
Directly  convalescence  is  firmly  established :  Sea  air.  Very  generous  diet. 
Cod-liver  oil.  Quinine  and  steel.  Strychnia,  or  nux  vomica.  Faradiza- 
tion. 

DIPLOPIA. — From  JotAooc,  double;  oTtTo/mt,  to  see.  Synon.  Ambiopia ; 
D/ttopsia;  Double  Vision. — Arises  from  some  derangement  in  the  visual 
axes,  or  some  irregularity  in  density  or  curvature  of  dioptric  media,  or 
some  disease  of  retina  or  optic  nerve. — See  Amaurosis. 

DIPSOMANIA. — From  dc-^a,  thii-st ;  fxavta,  madness. — An  intense  crav- 
ing for  intoxicating  liquors;  attended  with  a  protracted  state  of  general 
depression  and  restlessness.  An  unphilosophical  and  dangerous  view  to 
regard  a  dipsomaniac  as  an  irresponsible  being.  Hard  drinking  a  de- 
grading vice:  difficult  to  discontinue,  the  more  it  is  indulged  in. 

Excessive  use  of  alcoholic  stimuli  leads  to :  Induration  of  portions  of 
nervous  centres.  Congestions  of  respiratory  organs.  Amyloid  and 
fatty  degeneration  of  liver.  Chronic  inflammation  and  thickening  of 
walls  of  stomach.  Disease  of  substance  of  heart,  and  of  kidneys.  Cir- 
rhosis, or  gin  drinker's  liver.     Drops}^.     Tuberculosis. 

Treatment.  Total  abstinence  from  intoxicating  drinks.  Henbane, 
hop,  or  small  doses  of  opium,  to  avoid  sleepless  nights.  Bark  and  min- 
eral acids,  376.  Quinine,  379.  Quinine  and  nux  vomica,  387.  Phos- 
phate of  iron,  405.  Phosphate  of  zinc,  414.  Oxide  of  zinc,  415.  Hypo- 
pliosphite  of  soda  or  lime,  419.  Pepsine,  420.  Nourishing  food.  Milk. 
Fruit  syrups  in  soda  water.  In  almost  hopeless  cases  it  may  be  justi- 
fiable to  substitute  opium  for  alcohol.  Opium-eating  much  less  injurious 
than  alcohol  to  general  health;  while  the  subject  of  it  is  not  an  intoler- 
able nuisance  like  the  drunkard. — See  Delirium  Tremens. 

DIURESIS. — From  Aca,  through;  oufjicu,  to  pass  urine.  Synon.  Dia- 
betes Itisipidus. — A  condition  in  which  an  excessive  quantity  of  pale 
limpid  urine  is  secreted,  free  from  sugar  or  other  abnormal  ingredient. 

Symptoms.  Insatiable  thirst  (polydipsia),  with  excretion  of  large 
quantities  of  urine.  AVatery  constituents  of  latter  alone  increased; 
total  amount  of  urinary  solids  not  greater  than  in  health  :  in  exceptional 
eases,  however,  the  solids,  and  particuUirly  the  urea,  have  been  above 
the  average  (polyuria).  General  health  usually  sufters  :  annoying  thirst 
and  frequent  micturition  cause  bad  nights.     Sometimes,  dro])sy  sets  in. 

If  there  be  an  excess  of  urine  over  amount  of  liquid  taken,  one  of 
three  explanations  must  be  adopted :  (1)  Either  the  body  becomes 
poorer  in  water,  and  so  loses  weight.  (2)  Or,  water  is  absorbed  by  skin 
and  lungs.  (3)  Or,  water  is  formed  in  system  by  direct  union  of  its 
elements — oxygen  and  hydrogen  (Parkes). 

Treatment.  Tincture  of  perchloride  of  iron,  101.  Phosphoric  acid 
and  nux  vomica,  376.  Iron  alum,  116.  Gallic  acid,  103.  Opium.  Warm 
baths.     Cod-liver  oil.     Enforced  abstinence  from  fluids  useless. 

Remedies  sometimes  employed :  Ergot  of  r^^e.  Mineral  acids.  Tannic 
acid.  Oxide  of  zinc.  Iodide  of  potassium.  Green  iodide  of  mercury. 
Valerian.     Assafoetida.     Camjihor.     Nitrate  of  potash. 

DRACONTIASIS. — From  Apd/.iuv,  a  serpent.  Sj^non.  Malus  Dracuncu- 
Ins;  Helminthoncus  Medinensis. — A  helminthic  disease,  produced  in  the 
human  body  by  the  Guinea-worm. — Dracunculus  Medinensis,  Filaria 
medinensis,  or  Guinea-worm,  has  a  slender  cylindrical  body,  sometin\es 


96  DROPSY. 

nearly  as  thick  as  a  crow-quill,  and  from  one  to  twelve  feet  in  length. 
Endemic  in  some  parts  of  Asia  and  Africa,  especially  in  marshy  districts : 
individuals  returning  from  these  countries  occasionally  bring  tliis  nema- 
tode helminth  with  tliem. — Common  seat  of  the  Guinea-worm,  in  human 
body,  is  the  sulicutaneous  areolar  tissue  of  feet  and  legs. 

Symptoms.  May  be  absent  for  some  months:  then  a  feeling  of  irrita- 
tion in  aifected  part,  when  a  cord-like  ridge  ma}'  be  felt.  Constitutional 
disturbance;  fever,  headache,  nausea,  colic,  debility.  A  kind  of  boil 
forms:  sometimes  pustule  breaks,  and  head  of  worm  protrudes. 

Treatment.  Curative:  When  head  protrudes,  a  thread  to  be  placed 
round  it  and  rolled  on  a  piece  of  stick  or  bougie;  day  by  day  drawing 
worm  out,  and  winding  it  round  the  stick  until  extraction  is  complete. 
When  worm  does  not  protrude,  it  may  be  exposed  by  incision  ;  parasite 
being  removed  in  a  loop,  or  a  wedge  of  wood  being  inserted  around 
which  it  is  to  be  wound  Avithout  fracture. 

Prophylactic :  Feet  to  be  well-protected,  when  travelling  in  districts 
where  Guinea-worm  is  found.  Thorough  drying  of  feet  after  bathing, 
or  wading  through  marshy  districts.  Avoidance  of  13'ing  on  the  ground 
with  any  part  of  body  exposed  to  the  soil. 

DROPSY. — Formerly  correctly  called  hydropsy,  from  "TSwp,  water,  and 
©%/'£?•,  an  appearance.  An  accumulation  of  watery  or  serous  liquid  in 
some  one  or  more  of  the  natural  serous  cavities  of  the  body,  or  in  the 
meshes  of  the  areolar  tissue,  or  in  both,  often  occurring  independently 
of  inflammation. 

A  result  of  over-distension  of  the  veins  and  their  capillaries,  and  hence 
may  arise  from  many  different  conditions.  The  most  common  are  :  Pres- 
sure of  tumors,  enlarged  glands,  gravid  uterus,  &c.,  on  veins.  Structural 
disease  of  liver,  impeding  return  of  blood  through  the  portal  system  of 
veins.  Valvular  disease  of  the  heart.  Retarded  circulation,  with  in- 
ci'eased  fulness  of  veins,  in  pulmonary  emj^hysema,  bronchitis,  &c. 
Chronic  inflammatory  hyperaemia,  as  is  seen  in  strumous  ascites,  hy- 
drocele, &c.  Blood  poisoning, — as  in  acute  renal  dropsy,  where  the 
kidneys  become  congested  and  inflamed,  the  circulation  through  their 
capillaries  is  impeded,  and  urea  is  retained  in  the  blood.  And  anaemic 
or  watery  blood. — See  Anasarca;  Ascites;  Hydrocephalus ;  Hydrothorax ; 
Hydropericardium ;  Hydrocele,  &c. 

Treatment.  Purgatives.  Diuretics.  Diaphoretics.  Emetics.  Al- 
teratives.    Tonics.     Tapping.     Incisions  or  acupunctures.     Issues. 

Purgatives:  Calomel,  159.  Jalap,  140,  159.  (Jompound  jalap  powder. 
Compound  scammony  powder.  Compound  pill  of  gamboge.  Elaterium, 
157.  Croton  oil,  168.  Black  hellebore.  Tobacco.  Oil  of  turpentine, 
190.  Acid  tartrate  of  potash,  228.  Rhubarb.  Colocynth.  Resin  of 
podophjdlum. 

Diuretics :  Acetate  of  potash,  219.  Digitalis,  219.  Squills,  219.  Ni- 
trate of  potash,  212.  Buchu,  222.  Senega,  214.  Compound  spirit  of 
horseradish.  Spirit  of  nitrous  ether.  Tincture  of  cantharides.  Oil  or 
spirit  of  juniper,  229.  Infusion  of  uva  ursi.  Liquor  potassas.  Fomen- 
tations to  loins.  Cupping  or  leeches  to  loins.  Dry  cupping  over  the 
kidneys. 

Diaphoretics:  Tartarated  antimony,  210,  213.  Antimonial  powder. 
Opium.  Powder  of  ipecacuan  and  opium.  Elder-flower  water.  Guai- 
acum,  43.  Hot-water  baths,  119.  Hot-air  or  vapor  baths,  130.  Wet- 
sheet  packing,  136. 

Emetics:  Ipecacuanha,  231,  233.     Sulphate  of  zinc,  232.     Mustard. 

Alteratives:  Corrosive  sublimate,  27.    Compound  pill  of  calomel.   Mer- 


DROWNING — DUODENAL   DISEASES.  97 

cury  and  chalk.     Blue  pill.     Colchicum,  46.     Liquor   arsenicalis,  52. 
Chlorate  of  potash,  61.     Iodide  of  potassium,  31. 

Tonics:  Nitric  acid,  147.  Nitro-liydrochloric  acid,  378.  Tincture  of 
perehloride  of  iron.  Citrate  of  iron  and  ammonia.  Citrate  of  iron  and 
quinia.     Iodide  of  iron,  32.     Tartarated  iron.     Cod-liver  oil. 

DROWNING. — For  the  restoration  of  the  asphyxiated  from  submer- 
sion, see  Suspended  Animation. 

DUODENAL  DISEASES.— From  Duodeni,  twelve;  because  this  portion 
of  bowel  was  said  by  the  ancients  to  be  as  long  as  the  breadth  of  twelve 
fingers. — Great  difficulty  in  diagnosing  diseased  conditions  of  duodenum 
from  those  of  small  intestines  generally. 

1.  Duodenitis. — Synon.  Dodecadactylitis. — Acute  inflammation  seldom 
limited  to  duodenum:  generally  complicated  with  similar  disease  in 
stomach,  jejunum,  or  ileum;  or  with  inflammation  of  gall-bladder,  or 
under  surface  of  liver,  accompanied  by  jaundice. 

Symptoms.  Probably  pain  about  epigastric  and  right  hypochondriac 
regions;  perhaps  onl}'  becoming  severe  about  three  hours  after  taking 
food.  Thirst.  Unaltered  or  even  increased  appetite.  Nausea  and  vom- 
iting. Diarrhoea,  with  unnatural  and  offensive  stools.  Weakness,  men- 
tal anxiety,  and  loss  of  flesh. — When  complicated  with  inflammation  of 
the  biliary  apparatus,  or  when  due  to  the  irritation  set  up  by  a  gall- 
stone (which  may  cause  inflammation,  ulceration,  and  perforation  of  the 
walls  of  the  gall-bladder  and  intestines,  so  as  to  allow  of  its  escape  into 
the  duodenum),  there  will  be  jaundice  with  the  usual  results.  If  there 
be  also  pancreatic  disease  the  liquid  stools  will  contain  fatty  matters. 

Treatment.  Castor  oil,  or  calomel  as  an  aperient.  Opium.  Solution 
of  acetate  of  ammonia.  Mucilaginous  drinks.  Milk  diet.  Linseed 
poultices.     Poppy-head  fomentations. 

2.  Duodenal  Dyspepsia. — Either  the  result  of  chronic  or  subacute  in- 
flammation, or  simply  of  impaired  function. 

Symptoms.  Pain  about  duodenum  some  three  hours  after  food  has 
been  taken.  Nausea.  Attacks  of  faintness.  Occasionally,  jaundice  ;  es- 
pecially when  the  disease  is  caused  by  abuse  of  alcoholic  drinks.  Well- 
marked  tenderness  about  right  hypochondrium  ;  partlj'  owing  to  in- 
flamed condition  of  intestine,  and  partly  to  sympathetic  irritation  about 
liver. 

Treatment.  Mercury  and  chalk.  Mercury  and  chalk  with  opium, 
34.  Rhubarb  and  blue  pill,  171.  Nitric  acid,  senna,  and  taraxacum, 
147.  Nitro-hydrochloric  acid,  378.  Quinine  and  rhubarb,  178,  370,  385. 
Ipecacuan,  rhubarb,  and  oxide  of  silver,  179.  Ammonia  and  ox  bile, 
170.     Ammonia  and  chiretta,  63. — See  Dyspepsia. 

3.  Perforating  Ulcer  of  Duodenum. — Presents,  in  a  mitigated  form, 
many  of  the  symptoms  of  ulcer  of  stomach.  There  may  be  diarrhoea 
with  bloody  stools;  nausea  and  vomiting;  great  prostration,  &c.  Fatal 
perforation  sometimes  occurs-  suddenly  where  premonitory  symptoms 
have  been  mild.  A  sloughing  ulcer  is  perhaps  liable  to  form  in  upper 
part  of  duodenum  within  a  few  days  of  a  severe  burn. — See  Gastric 
Ulcer. 

4.  Cancer  of  Duodenum. — As  a  primary  aflPection  very  rare.  Not  un- 
frequentl}^  the  duodenum  is  secondarily  involved  in  progress  of  hepatic 
cancer,  and  in  malignant  disease  of  pancreas  or  neighboring  lymphatic 
glands.  Colloid  form  most  common.  When  the  diseased  mass  presses 
on  the  ductus  communis  there  will  be  jaundice. — Death  may  occur  from 


98  DYSENTERY. 

inanition,  or  from  peritonitis  the  result  of  perforation,  or  from  obstruc- 
tion of  the  bowel. — See  Gastric  Cancer. 

DYSENTERY. — From  Auq,  difficulty  or  badness;  k'vTspov,  intestine. 
Synon.  Colitis;  Colorectitis ;  Bloody  Fhix. — A  specific  inflammation  and 
ulceration  of  mucous  lining  (occasionally  also  of  other  tissues)  of  the 
colon,  especially  perhaps  of  lower  part  of  this  gut  and  rectum  ;  attended 
with  febrile  disturbance,  severe  griping  pains,  mucous  and  bloody  stools, 
and  great  prostration.  Has  been  improperly  termed  colitis  (^Colon,  the 
large  gut;  terminal  -itis);  cases  occurring  where  ulceration  does  not 
stop  at  ilio-cfecal  valve,  but  extends  several  inches  up  small  intestines. 

Severe  dysentery  rare  in  this  country.  Sometimes  breaks  out  in  un- 
healthy localities.  In  tropics  often  veiy  fatal. — Has  been  ascribed  to 
wet  and  cold,  contagion,  malaria,  polluted  water,  intemperance,  depri- 
vation of  fresh  fruit  and  vegetables,  bad  or  insufficient  or  salt  food,  in- 
sufficient clothing,  &c. 

Symptoms.  Acute  form :  Uneasiness  and  pain  in  abdomen  of  a  griping 
character  (tormina,  from  Torqueo,  to  torture),  with  frequent  inclination 
to  go  to  stool.  As  ulceration  commences,  desire  to  empty  bowel  be- 
comes more  frequent,  and  is  followed  by  shorter  interval  of  ease.  Evacu- 
ations scanty,  thin,  mucous,  blood}^;  mixed  with  small  hard  lumps  of 
faeces  (scybala,  from  l7(.o,3aXov,  excrement).  The  scanty  stools  produce 
great  distress;  griping,  and  straining  without  any  evacuation  (tenesmus, 
from  Tsivu},  to  strain);  peculiarly  fetid  and  dark-colored  motions,  mixed 
with  blood  and  purulent  matter  and  shreds  of  lymph  ;  and  frequent  mic- 
turition. Urine  high-colored;  gives  rise  to  scalding.  Sometimes  con- 
stant desire  to  micturate,  only  a  few  drops  coming  away  at  a  time 
(strangury,  from  Izpay^,  a  drop;  ovpov,  urine).  Great  constitutional  dis- 
turbance and  prostration. 

May  end  in  perforation  of  bowel  and  fatal  peritonitis :  in  rupture  and 
fecal  abscess  :  in  ichorhremia  and  secondary  abscesses  :  in  fatal  exhaus- 
tion. After  healing  of  ulcerations  in  favorable  cases  there  may  be 
troublesome  constipation  from  contraction  of  cicatrices. 

Chronic  variety :  Most  intractable.  Often  causes  atrophy  of  mucous 
membrane  with  degeneration  of  intestinal  glands:  or  imperfectly  cica- 
trized ulcers  remain  in  tissues  of  caecum,  colon,  or  rectum.  Most  cases 
recover.  Sometimes,  however,  patient  gradually  wastes  :  skin  gets  di'y 
and  scaly:  improvement  one  day  with  relapse  the  next:  discharges  of 
fecal  matter,  mixed  with  thin  pus  and  blood,  most  offensive :  the  ex- 
haustion, pains,  tenesmus,  &c.,  render  death  welcome. 

Treatment.  Acute:  Pei'fect  rest  in  bed,  in  well-ventilated  room. 
Demulcent  drinks.  Ice.  Farinaceous  food  :  milk  or  cream  :  thin  broths. 
Warm  bath.  Fomentations:  linseed  poultices:  wet  compress.  A  few 
doses  of  castor  oil  (164)  if  there  be  lodgment  of  scj^bala.  Ipecacuanha 
often  most  valuable,  given  thus:  Interdict  use  of  fluids  for  three  hours: 
apply  a  large  hot  linseed  poultice,  containing  two  or  three  tablespoon- 
fuls  of  mustard,  over  epigastrium  :  a  full  dose  of  opium  in  form  of  enema 
or  suppository  :  thirty  or  forty  minutes  subsequently  give  from  thirty 
to  sixty  grains  of  ipecacuan  powder  in  form  of  bolus,  in  mucilaginous 
drauglit,  or  wrapped  up  in  wafer-paper;  repeating  dose,  if  neeessarj^,  at 
end  of  six  or  twelve  or  twenty-four  hours.  Subsequently:  Opiate  sup- 
positories or  enemata,  339,  340.  If  there  be  weakness  and  anaemia,  sal- 
icine;  quinine;  bark  and  ether;  cascarilla;  or  some  mild  preparation 
of  steel.  If  stools  continue  numerous  and  frothy  and  bloody,  bismuth; 
gallic  acid;  kino;  logwood;  sulphate  of  copper.  In  scorbutic  cases, 
lemon  or  orange  juice.  Generous  diet;  milk  or  cream,  raw  eggs,  strong 
broths,  ripe  grapes,  perhaps  stimulants.     Restorative  soup,  2. 


DYSMENORRHCEA.  99 

Remedies  sometimes  em-ployed :  Bloodletting.  Leeches  to  anus.  Emetics. 
Calomel.  Compound  powder  of  jaliip.  Sulphur.  Acid  tartrate  of  pot- 
ash. Nitrate  of  silver.  Tartaric  acid.  American  hellebore  (Veratrum 
viride).  Belladonna.  Hydrocyanic  acid.  Narcotine.  Infusion  of  lin- 
seed. Mucilage  of  tragacanth.  Tobacco  fomentations.  Turpentine 
stupes. 

Chronic  or  subacute :  Residence  in  a  mild,  dry,  equable  climate.  Sea 
voyage.  Warm  clothing.  Constant  use  of  flannel  roller  round  belly. 
Plain  animal  food  :  milk  or  cream  :  raw  eggs.  Grapes :  oranges.  Mor- 
phia. Chloroform,  morphia,  and  Indian  hemp,  317.  Liquid  extract  of 
bael,  58,  97.  Sumbul  and  ether,  95.  Pill  of  lead  and  opium  (officinal). 
Sulphate  of  copper  and  opium,  106.  Nitrate  of  silver  and  opium,  107. 
Kino  and  logwood,  108.  Matico  and  rhatany,  105.  Gallic  acid,  103. 
Alum  and  sulphuric  acid,  115.  Tannic  acid  lozenges.  White  bismuth, 
65,  112.  Vegetable  charcoal,  98.  Iron  alum,  116.  Tincture  of  perchlo- 
ride  of  iron.  Reduced  iron.  Nitro-hydrochloric  acid,  378.  Pepsine, 
420.     Cod-liver  oil.     Qui4une,  rhubarb,  and  hop,  370. 

DYSMENORRHCEA.— From  Au<;,  difficulty ;  /j.rjv,  a  month  ;  ^ioj,  to  flow. 
Synon.  Paramenia  Difflcilis ;  Menstrua  Dolorosa ;  Amenorrhoea  Partialis  ; 
Laborious  or  Difficult  Menstruation. — Three  distinct  varieties : 

1.  Neuralgic  Dysmenorrhcea.  —  Afflicts  nervous  women,  in  delicate 
health,  about  time  of  puberty:  or  may  come  on  after  some  years  of 
painless  menstruation,  especially  in  those  who  have  never  been  preg- 
nant. 

Symptoms.  Malaise,  headache,  with  pain  about  sacrum  and  lower 
part  of  abdomen  for  a  few  da3^s  prior  to  period.  Soi'eness  of  inner  and 
upj)er  part  of  thighs.  Bearing-down,  with  sense  of  pelvic  Aveight.  If 
discharge  comes  on  freely,  relief  experienced.  Commonly,  flow  is 
scanty — slight  gushes:  suffering  becomes  acute.  Pain  lessens  and  re- 
turns. Hysteria.  Flatulence  and  constipation.  Pain  probably  in 
ovaries,  rather  than  in  uterus.     No  swelling  or  heat  of  parts. 

Treatment. — During  paroxysm :  Hot  hip  bath  for  thirty  or  forty-five 
minutes.  Bath,  with  extract  of  poppies  and  carbonate  of  soda  (an  ounce 
of  each).  Pessary  of  oxide  of  zinc  and  belladonna,  or  of  iodoform,  423. 
Indian  hemp,  aconite,  ether,  and  juniper,  342.  Morphia,  chloroform, 
and  Indian  hemp,  317.  Opium  and  henbane,  with  hot  gin  and  water, 
343.  Hypodermic  injection  of  morphia,  314.  Linseed,  or  hemlock, 
poultice  to  abdomen  and  vulva. 

During  interval:  Quinine  and  mineral  acid,  379.  Bark,  phosphoric 
acid,  and  aconite,  376.  Salicin,  388.  Hypophosphite  of  soda  and  sum- 
bul, 419.  Cod-liver  oil,  389.  Compound  rhubarb  pill.  Effervescing 
citrate  of  magnesia.  Taraxacum  juice.  Pepsine,  420.  Iodide  of  lead 
and  belladonna  pessaries,  423.  Chamomile  tea.  Nourishing  food  :  sub- 
stitution of  milk  or  cocoa  for  tea  and  coffee.  Wine ;  weak  brandy  and 
water;  bitter  ale.     Avoidance  of  sexual  intercourse.     Warm  sea  baths. 

2.  Congestive  Dysmenorrhcea. — Synon.  Membranous  Dysynenorrhoea. — 
Generally  occurs  at  later  period  of  life  than  neuralgic  form. 

Symptoms.  Suffering  begins  four  or  five  days  before  each  period. 
Backache;  weariness  and  i-estlessness;  sense  of  pelvic  weight ;  irrita- 
bility of  bladder.  Hemorrhoids;  frequent  flushings  ;  throbbing  uterine 
pain.  Discharge  comes  on  gradually  :  scanty  at  commencement;  relief 
follows  abundant  flow.  Clots,  and  shreds  or  flakes  of  membrane  ex- 
pelled: sometimes,  pear-shaped  casts  of  uterine  cavity,  formed  of  epi- 
thelial lining  of  uterus,  analogous  to  decidua.     Uterus  found  congested, 


100  DYSPEPSIA. 

lips  oedematous,  on  examination;  sometimes  displaced  :  ovaries  tender. 
Swelling  and  tenderness  of  breasts. 

Treatment.  During  paroxysm  :  Same  as  for  neuralgic  form.  Three 
or  four  leeches  to  labia  uteri.     Scarification  of  labia. 

During  interval:  Mercury  and  conium,  or  iodide  of  lead  and  bella- 
donna, pessaries,  423.  Corrosive  sublimate,  27.  Iodide  of  potassium,  31. 
Bromide  of  potassium,  42.  Mercurial  vapor  baths,  131.  Colchicum.  46. 
Cod-liver  oil.  Plain  living:  absence  of  stimulants.  Avoidance  of  sexual 
intercourse.     Moderate  exercise  in  open  air.     Sea  air. 

3.  Mechanical  Dysmenorrhcea. — That  form  in  wnich  there  is  stricture 
of  internal  or  external  os  uteri;  or  a  narrowing  of  entire  canal  of  cer- 
vix; or  some  uterine  tumor;  or  uterine  displacement — retroflexion  or 
antiflexion.  Ensuing  remarks  apply  only  to  the  variety  due  to  stric- 
ture of  internal  or  external  os,  or  to  narrowing  of  entire  cervical  canal; 
conditions  causing  sterility  as  well  as  dysmenorrhcea. 

Symptoms.  Indicative  of  obstruction  to  escape  of  menstrual  fluid.  A 
scanty  flow  :  discharge  escapes  in  gushes  ;  each  gush  attended  by  pain. 
Backache.  Irritability  of  bladder.  Congestion  and  tenderness  of  ova- 
ries. Examination  reveals  a  very  small  os  uteri ;  or  an  orifice  of  normal 
size,  stricture  being  detected  by  uterine  sound  at  internal  os.  Some- 
times, OS  uteri  only  slightly  smaller  than  natural ;  but  under  influence 
of  menstrual  molimen  spasmodic  contraction  occurs,  with  all  the  suffer- 
ing of  organic  stricture. 

Treatment.  Incision  of  uterine  canal  with  hysterotome  (Routh's  or 
Simpson's);  followed  by  plugging  with  oiled  lint,  or  introduction  of  a 
spring-stem  pessary  (Green halgh's).  Dilatation  by  sea- tangle  or  sponge- 
tents,  less  likely  than  incision  to  effect  permanent  cure;  and  more 
apt  to  be  followed  by  pelvic  cellulitis,  metritis,  or  ovaritis.  Dilatation 
by  bougies,  useless. 

DYSPEPSIA. — From  Jt»c,  difficult ;  r^Trrto,  to  digest.  Synon.  Apepsia; 
Digestio  Difficilis;  Concoctio  Tarda;  Indigestion. — Anything  which  inter- 
feres with  the  healthy  action  of  stomach  and  intestines  may  give  rise 
to  indigestion. 

Symptoms.  Variable  in  nature  and  severity.  Loss  of  appetite.  Pain, 
weight,  and  fulness  at  ejDigastrium,  especially  after  eating.  Flatulence. 
Nausea  and  vomiting.  Costiveness  alternating  with  diarrhoea.  Furred 
tongue  and  foul  breath.  Palpitation.  Headache.  Pains  in  loins  and 
limbs.    Heartburn.    Cramp  in  stomach.    Water-brash.   Hypochondriasis. 

In  slow  digestion  from  scanty  secretion  of  gastric  juice, — a  feeling  of 
fulness  and  distension  in  left  hypochondrium,  and  at  pit  of  stomach, 
after  food.  Flatulence;  sour  eructations;  constipation;  coated  tongue; 
palpitation  and  irregular  action  of  heart;  headache  and  mental  depres- 
sion, &c. 

Treatment.  General  Directions:  Digestion  to  be  improved  by  means 
which  invigorate  system  generally:  Rest  and  early  hours.  Relaxation 
from  severe  studies,  or  from  harassing  cares  and  anxieties  of  business. 
One  day's  holiday  in  every  seven.  Change  of  air:  sea-bathing.  Cold 
or  tepid  sponging.  Wet  compress  over  stomach,  136.  Horse  exercise: 
brisk  walking.  Disuse  of  tobaccco.  Alcoholic  stimulants  in  great 
moderation. 

Regulation  of  Diet:  Plain  food  in  small  quantities.  Gruel;  sago;  ar- 
rowroot. Weak  tea  with  milk.  Milk  and  water.  Lime-water  and 
milk.  Stale,  or  unfermented,  or  aerated  bread.  White  fish. — especially- 
sole,  whiting,  brill,  turbot.  Poultry;  sweetbread;  tripe;  mutton;  ven- 
ison; pheasant;  hare.  Dry  sherry:  dry  Ruster,  Ofner  Auslese,  Carlo- 
witz,  Szamarodnya  Muscat,  or  other  white  Hungarian  wines.     Weak 


DYSPHAGIA — DYSPHONIA    CLERICORUM.  101 

cold  brandy  and  water.  Simple  aerated  water:  soda  water.  Coffee, 
without  chicory,  but  not  after  dinner. — Avoidance  of:  Vegetables,  save 
cauliflower,  asparagus,  vegetable  marrow:  of  raw  fruit, — save  grapes 
and  oranges:  of  pastry,  cheese,  beer,  port  wine,  and  undiluted  spirits: 
of  rapid  mastication  and  huny  at  meal  times. 

Drugs:  Pep8ine,420.  Pepsine  and  aloes,  155.  Pepsine  and  steel,  394. 
Rhubarb.  Ipecacuanha  and  rhubarb,  179.  Quinine  and  rhubarb,  178. 
Rhubarb  and  blue  pill,  171.  Rhubarb  and  magnesia,  165.  Ammonia 
and  rhubarb,  161.  Purified  ox  bile,  170.  Nux  vomica,  175.  Steel  and 
hydrochloric  acid,  397.  Steel  and  citrate  of  potash,  403.  Quinine,  rhu- 
barb, and  hop,  370.  Carbonate  of  ammonia,  361.  Nitro-hydi-ochloric 
acid,  378.  Salicin,  388.  Nitrate  of  silver.  Oxide  of  silver.  White 
bismuth.  Bicarbonate  of  potash.  Ipecacuanha.  Blue  pill.  Mercury 
and  chalk.  Taraxacum.  Nitric  acid.  Saccharated  solution  of  lime. 
Wood  charcoal.  Oxalate  of  cerium.  Hydrocyanic  acid.  Lactic  acid. 
Tannic  acid.  Gentian.  Quassia.  Hop.  Kino.  Serpentary.  Chiretta. 
Cascarilla.  Calumba.  Compound  tincture  of  cardamoms. — See  Gas- 
tralgia;  Gastrodynia ;  Pyrosis. 

DYSPHAGIA. — From  Jt^c,  difficulty;  ^aj'w,  to  eat.  Synon.  Deghititio 
Impcdlta;  Difficulty  of  Deglutition. — Difficulty  in  swallowing  is  a  promi- 
nent symptom  in  disease  of  pharynx  and  oesophagus, — as  inflammation, 
ulceration,  stricture,  spasmodic  contraction,  polypus,  or  cancer.  It  may 
also  arise  from  glossitis,  acute  or  chronic  tonsillitis,  diphtheria,  croup. 
From  erysipelatous  or  other  inflammation  of  areolar  tissue  of  neck. 
Retro-pharyngeal  abscess.  Glosso-laryngeal  paralysis ;  paralysis  of 
muscles  of  degkitition  ;  progressive  paralysis  of  insane  ;  progressive  mus- 
cular atrophy  ;  paralysis  agitans.  Tetanus.  Myelitis.  Malignant,  syphi- 
litic, and  tubercular  ulcerations  about  epiglottis.  Syphilitic  ulceration 
of  velum  and  fauces.  The  pressure  of  aneui'ismal  or  other  tumors. 
Spasm  of  pharynx  and  oesophagus,  as  in  hj-drophobia.  Inflammation, 
ulceration,  or  oedema  of  larynx.  And  rarely,  from  disease  of  laryngeal 
cartilages. 

DYSPHONIA  CLERICORUM.— From  Ju?,  difficulty  or  pain  ;  ^wi/vy,  the 
voice:  Clericus,  a  clergyman.  Synon.  Follicular  disease  of  Pharyngo- 
laryngeal  membrane. — Frequently,  a  nervous  complaint;  unattended  in 
early  stage  by  any  organic  lesion,  but  consisting  of  hypersesthesia  or 
irritability  of  investing  membrane  of  fauces.  Subsequently,  congestion 
or  inflammation  or  relaxation  of  mucous  membrane ;  enlargement  of 
tonsils;  elongation  of  uvula ;  irritation,  inflammation,  morbid  deposit, 
and  ulceration  of  mucous  follicles  about  isthmus  fauciura. — Clergymen, 
barristers,  public  sjDeakers,  actors,  singers,  &c.,  most  liable  to  this  dis- 
ease. 

Symptoms.  Uneasy  sensations  in  upper  part  of  throat,  with  frequent 
inclination  to  swallow,  as  if  there  were  something  in  oesophagus.  Cough- 
ing, hawking,  and  spitting  of  phlegm.  Uneasiness  or  pain  about  larynx. 
Diminution  in  power  of  voice:  hoarseness,  especially  towards  evening; 
sometimes  aphonia.  Unhealthy  granular  appearance  of  fauces.  Mucous 
follicles  seem  to  be  filled  with  yellowish  matter.  A  viscid  muco-purulent 
secretion  adhering  to  palate  and  velum. 

Treatment.  Early  stage:  Quinine  and  iron,  380.  Steel  and  pepsine, 
394.  Quinine  and  nux  vomica,  387.  Phosphate  of  iron,  405  Iron  alum, 
116.  Cold  shower  baths,  or  sea-bathing.  Rest  of  voice.  Temporary 
change  of  scene  and  occupation. 

Confirmed  stage:  Iodide  of  potassium,  31.  Iodide  of  iron,  32,  390. 
Iodide  of  ammonium,  38.     Bromide  of  ammonium,  37.     Corrosive  sub- 


102  DYSPN(EA — ECTHYMA. 

limate,  27.  Phosphate  of  zinc,  414.  Stiyohnia  and  steel,  408  Steel 
and  chlorate  of  potash,  402.  Quinine,  steel,  and  arsenic,  381.  Phos- 
phoric acid,  mix  vomica,  and  bark,  376.  Cod-liver  oil.  389.  Nourishing 
food.  Sea  air.  Undercliff,  434.  Torquay,  436.  Pau,  443.  Malaga, 
445.     Algiei's.  451. 

Local  applications :  Inhalation  of  atomized  alterative  or  astringent 
fluids,  262.  Sponging  diseased  parts,  including  interior  of  larynx,  with 
solution  of  nitrate  of  silver  (gr.  40 — 60  of  crystals  to  fl.  oz.  j).  Outside 
of  throat  to  be  protected:  beard  to  be  worn.  Excision  of  tonsils,  if 
they  be  affected  with  chronic  enlargement  and  induration. 

DYSPN(EA.— From  Auq,  difficulty;  --Au,^  to  breathe.  Synon.  Pseudo- 
Asthma;  Bespiratio  Dijficilis ;  Short  Breath. — Difficulty  of  breathing  a 
prominent  symptom  in  many  acute  diseases.  May  be  due  to  poisoned 
or  impoverished  state  of  blood  ;  dropsy;  hysteria;  paralysis  of  muscles 
of  respiration  ;  obstruction  of  air-tube  by  pressure  of  aneurismal  and 
other  tumors,  foreign  bodies,  false  membranes,  oedema  of  glottis;  asthma; 
laryngismus  stridulus  ;  disease  of  lungs;  or  to  disease  of  heart. 

ECLAMPSIA  NUTANS.— From  'ExXd^r.io,  to  emit  brilliant  light ;  Nuto, 
to  nod.  Sj'non.  Salaam  Convulsions  of  Infancy. — A  rare  disease  of  in- 
fants: attended  with  a  frequent  bowing  of  the  head.  Probably  a  form 
of  epilepsy.     Sometimes  leads  to  impairment  of  intellect. 

Symptoms.  A  peculiar,  involuntarj ,  rapid  bowing  forward  of  the 
head,  and  occasionally  of  the  body.  Bowings  rejjeated  in  rapid  succes- 
sion :  attacks  come  on  in  paroxysms  several  times  in  day.  Most  severe 
seizures  usually  occur  in  morning,  on  awaking  from  night's  rest.  After 
a  time, — cerebral  sj'mptoms;  convulsions;  pure  epilepsy;  hemiplegia 
or  paraplegia;  general  wasting;  in  favorable  cases,  symptoms  remit  at 
end  of  some  months  ;  bodily  health  com2)letely  restored  in  two  or  three 
years. 

Treatment.  Intestinal  secretions  to  be  kept  healthy  by  mild  altera- 
tives,— mercury  and  chalk,  rhubarb  and  soda,  syrup  of  senna.  Tonics, 
bark  and  ammonia ;  quinine  ;  phosphate  of  iron  and  lime,  &c.,  405.  Cod- 
liver  oil,  389.  Nourishing  food.  "Warm  clothing.  Sea  air.  Tepid  salt 
water  baths.  As  palliatives. — chloroform  inhalation  :  small  doses  of 
hydrocyanic  acid.     Opium  aggravates  the  attacks. 

ECSTASY. — "Ev-azaaii;^  a  deep  trance ;  from  'E^iarr^tJ.'.,  to  put  a  person 
out  of  his  natural  state.  Synon.  Catalepsia  Spuria  ;  Trance. — A  con- 
dition analogous  to  the  cataleptic.  Patient  insensible  to  all  external 
impressions;  absorbed  in  contemplation  of  some  imaginary  object. 
Eyes  immovably  fixed :  impassioned  sentences,  fervent  prayers,  psalms 
and  hymns  are  recited  with  great  expression.  Religious  fanatics,  by  en- 
couraging some  predominant  idea,  fall  into  a  state  resembling  incipient 
stage  of  monomania.  "  Gift  of  unknown  tongues"  mo.stly  manifested  by 
nervous  w^omen  in  a  morbid  condition.  Faith,  imagination,  enthusiasm, 
and  especially  an  irresistible  propensity  to  imitation,  will  explain  the 
origin  of  tarantism,  dancing  mania,  convulsionaires  of  St.  Medard,  &c. 
— For  treatment,  see  Hysteria. 

ECTHYMA. — From  'ExOuu),  to  break  out  in  eruptions.  Synon.  Furun- 
cull  Atonici ;  Dartre  Crustacee ;  Phlyzacia  ;  Papulous  Scall. — Anon-con- 
tagious inflammation  of  the  skin;  characterized  by  large,  round,  promi- 
nent pustules,  occurring  upon  any  part  of  the  body.  Pustules  usually- 
distinct  ;  seated  upon  a  hard  inflamed  base ;  terminate  in  thick  dark- 
colored  scabs,  which  leave  superficial  ulcers  followed  by  cicatrices. — 


ECTROPION — ELEPHANTIASIS    GR^CORUM.  103 

May  be  acute,  and  preceded  by  lancinating  pains  with  fever:  more  com- 
monly chronic,  and  due  to  bad  living,  &c.  Often  met  with  on  scalp  of 
badly  nourished  infants.  In  ecthyma  cachecticum,  ulcers  assume  an  un- 
healthy appearance  :  general  health  much  deterioi'ated. 

Treatment.  Internally:  Mineral  acids  and  bark,  376.  Nitro-hydro- 
chloric  acid,  378.  Quinine  and  steel,  380.  Quinine,  steel,  and  arsenic, 
381.  Steel  and  aloes,  154.  Steel  and  sulphate  of  magnesia,  1G6.  Iodide 
of  potassium.  Opium.  Henbane.  Cod-liver  oil.  Nourishing  food. — 
Locally  :  Warm  or  tepid  baths.  Gelatine  baths,  132.  Water  dressing, 
dilute  solution  of  subacetate  of  lead,  oxide  of  zinc  ointment,  or  sub- 
acetate  of  lead  ointment  to  the  scabs  or  ulcers. 

ECTROPION, — From  "ExTpinw,  to  turn  from.  Synon.  Blepharotosls ; 
Divaricatlo  Palpebrarum. — Eversion  of  the  eyelid  may  be  due  to  long- 
continued  conjunctivitis,  or  to  the  contraction  of  one  or  more  cicatrices 
on  the  cheek,  or  to  dropping  of  lower  lid  from  paralysis.  More  com- 
mon with  lower  than  upper  lid. 

ECZEMA. — From  'ExUcu,  to  break  forth  in  pustules.  Synon.  Running 
Scall ;  Humid  Tetter. — A  very  common  non-contagious  skin  disease. 
Usually  classified  with  vesicular  diseases  :  more  correctly  belongs  either 
to  exanthematous  or  to  pustular  orders  (Milton).  A  portion  of  skin 
becomes  red,  inflamed,  and  stiff;  cuticle  desquamates  ;  a  discharge  of 
serum  takes  place  from  follicles  and  sebaceous  ducts  of  skin  ;  and  super- 
ficial moist  excoriations,  or  patches  of  ulceration,  covered  with  scabs  or 
crusts,  result.  General  health  depressed:  loss  of  appetite,  irritability, 
restlessness.     The  disease  may  be  acute  or  chronic. 

Treatment.  Internally:  Effervescing  citrate  of  magnesia,  169.  Rhu- 
barb and  magnesia,  165.  Ehubarb  and  blue  pill,  with  henbane,  171. 
Steel  and  sulphate  of  soda,  180,  181.  Quinine  and  steel,  380.  Phosphate 
of  iron,  405.  Steel  wine.  Pill  of  carbonate  of  iron.  Arsenic,  52.  Qui- 
nine, steel,  and  arsenic,  381.  Steel  and  arsenic,  399.  Cod-liver  oil,  389. 
Cod-liver  oil  chocolate.  Corrosive  sublimate,  27.  Bed  iodide  of  mer- 
cury, 54.  Red  iodide  of  mercury  and  arsenic,  55.  Opium.  Henbane. 
Indiam  hemp. — Animal  food :  milk  or  cream :  malt  liquors,  sherry, 
claret,  &c.     Exercise  in  pure  air. 

Locally :  Warm  baths.  Conium  and  starch  bath,  122.  Thin  gruel, 
barley  water,  or  simple  water  dressing.  Subacetate  of  lead  and  gly- 
cerine lotion,  264.  Glycerine  and  water  (equal  parts).  Carbonate  of 
soda  and  gl3'cerine  lotion,  268.  Lime  liniment.  Saturation  of  scabs 
with  washed  lard  or  olive  oil,  and  removal  by  linseed  poultices.  Oxide 
of  zinc  ointment.  Diluted  nitrate  of  mercury  ointment,  305.  Creasote 
and  red  oxide  of  mercury  ointment,  301.  lu  eczema  capitis,  the  hair  to 
be  cut  off  close  to  scalp. 

ELEPHANTIASIS  GR^CORTJM.  —  From  'EXiipa-,,  the  elephant,— 
owing  to  the  terrible  nature  of  the  disease,  and  its  causing  the  skin  to 
resemble  that  of  the  elephant.  Synon.  Elephantiasis  Anoisthetica ;  Lazari 
Malum;  True  Lepro.<iy.  —  A  terrible  and  dangerous  constitutional  or 
blood  disease;  gradually  becoming  more  and  more  rare.  It  is  endemic: 
affects  the  poor  and  badly  nourished  in  preference  to  the  well-fed :  non- 
contagious, hereditary,  and  generally  incurable. 

Characterized  by  patches  of  a  purple  color;  which  are  succeeded  by 
elevated  tumors,  irregular  in  shape  and  size,  soft  and  smooth  and  insen- 
sible to  touch,  and  which  generally  become  the  seat  of  unhealthy  ulcera- 
tion. Not  met  with  in  temperate  climates ;  there  is  found  to  be  a  pre- 
disposition to  it  towards  the  polar  regions  on  the  one  hand,  and  the 


104  EMBOLISM — EMPHYSEMA. 

tropics  on  the  other.  Males  suffer  more  than  females.  Designated  by 
the  Jews  tsaraiith. 

Elephantiasis  Grseeorum  appears  to  be  endemic  in  Lisbon.  The  first 
indication  of  it,  as  observed  there,  is  a  discoloration  in  patches,  of  skin 
of  face;  an  elongation  and  thickening  of  lobes  of  ear;  and  a  spreading 
out  of  alae  of  nose.  Face  gets  beset  with  tubercles;  features  become 
puffed  out  and  traversed  by  deep  lines;  lips  thicken;  whiskers  and 
eyebrows  and  eyelashes  fall  off.  Gradually  tubercles  extend  over  the 
limbs;  sensibility  of  mind  and  body  becomes  greatly  blunted,  until 
there  is  mere  animal  life.  After  some  years  tubercles  ulcerate;  there 
is  ozffina;  fingers  and  toes  become  gangrenous;  body  exhales  a  loath- 
some fetor.     Death  occurs  from  exhaustion,  diarrhoea,  or  erysipelas. 

Treatment.  Arsenic.  Nitro-hydrochloric  acid.  Nitric  acid.  Iodide 
of  potassium.  Iodide  of  iron.  Bromide  of  potassium.  Powdered  bark 
of  root  of  Mudar  (Calotropis  Gigantea;  Asclepias  Gigantea).  Bevilac- 
qua  (Asiatic  Pennywort;  Ilydrocotyle  Asiatica)  internally,  and  locally 
to  ulcerations.  Phosphorus.  Cod-liver  oil.  Sudorific  drinks.  Turkish 
baths.  Sulphur  baths.  Sea-water  baths.  Sea  air.  Nourishing  food : 
avoidance  of  salt  meats.  The  Jews  of  Morocco  are  said  to  employ,  as 
a  prophylactic  remedy,  brandy  distilled  from  raisins,  pears,  figs,  and 
dates. 

EMBOLISM. — From  "EnSohx;,  a  plug. — A  term  used  to  designate  a 
fibrinous  concretion  detached  and  transported  from  the  interior  of  the 
heart  or  of  some  vessel,  and  carried  onwai'ds  by  the  blood  until  the 
calibre  of  the  vessel  becomes  too  small  to  allow  of  further  progress. 
The  migratory  substance  is  called  an  embolus. 

Symptoms.  They  depend  upon  the  organ  in  which  the  embolus  is  ar- 
rested. Thus,  the  debris  of  a  clot  in  a  peripheral  vein  may  be  stopped 
in  capillaries  of  liver,  or  may  pass  through  these  vessels,  and  then  be- 
come arrested  in  more  minute  capillaries  of  lungs.  A  large  clot  fixed 
in  pulmonary  artery  will  induce  immediate  asphyxia;  or  if  able  to  pass 
on  into  lung,  may  be  the  cause  of  gangrene.  So  also,  obstruction  of  the 
chief  vessel  of  a  limb  will  induce  mortification.  Softening  of  brain  may 
result  from  plugging  of  one  of  the  branches  of  internal  carotid,  or  of 
one  of  the  arteries  in  fissure  of  Sylvius. 

Treatment.     See  Thrombosis. 

EMMETROPIA. — From  Enfierpoq,  in  regular  measure;  w^,  the  eye. 
Synon.  Normal-sightedness. — Emmetropia,  or  normal  vision,  exists  when 
a  well-defined  but  inverted  image  of  an  object,  at  an  ordinarily  visible 
distance,  is  formed  upon  the  compound  structure  known  as  the  retina. 
The  local  change  here  excited  must  be  convej^ed  to  the  fibres  of  the 
optic  nerve,  communicated  to  the  brain,  and  again  projected  outwards 
in  an  inverted  direction.  Through  this  double  inversion  the  projected 
image  corresponds  to  the  object;  and  men  say  that  they  see  the  object, 
although  only  the  projected  retinal  image  stands,  as  it  were,  before 
their  ej^es  (Donders).  The  emmetropic  eye  can  distinguish  the  pres- 
ence of  an  object  the  600th  of  an  inch  in  size  at  a  distance  of  six  inches. 
Can  read  Snellen's  types  at  indicated  distances. 

The  power  of  vision  often  injured  by  use  of  single  eyeglasses.  Light 
blue  spectacles — "conservative  spectacles" — do  harm,  the  retina  being 
benefited  by  the  stimulus  of  white  light.  It  would  be  as  wise  to  employ 
"  conservative"  crutches  to  spare  the  muscles. 

EMPHYSEMA. — From  "EiKfuirdw,  to  inflate.  Sj^non.  Pneumatosis  Pul- 
monum ;  Pneumectasis. — Two  varieties:   One  consisting  of  enlargement 


EMPYEMA — ENDOCARDITIS.  105 

of  air-cells,  atrophy  of  their  walls,  and  obliteration  of  their  vessels  (vesic- 
ular or  pulmonary  emphysema).  The  other  due  to  infiltration  of  air  into 
interlobular  areolar  tissue,  or  into  subpleural  areolar  tissues  (interlobu- 
lar em]ih3'sema).  Both  forms  produce  habitual  shortness  of  breath  ; 
occasional  paroxysms  of  asthma  ;  and  such  distress,  that  sutferer  is  unfit 
for  any  active  occupation.  They  often  lead  to  disease  of  right  cavities 
of  heart,  with  venous  congestion  and  di'opsy. 

1.  Vesicular  Emphysema. — May  affect  one  lung  or  both,  or  a  part  of 
each — especially  anterior  edges  and  apices. 

Symptoms.  Dj-spnaa,  increased  on  any  exertion.  Feeble  cough.  Ex- 
pectoration of  frothy  sputa.  Dusky  appearance  of  countenance.  Weak- 
ness of  voice.  Stooping  gait.  Loss  of  flesh  and  strength.  Lowered 
temperature  of  body.  Constipation.  Weak  and  slow  pulse.  Attacks 
of  asthma.  On  percussion, — unnatural  clearness  and  resonance.  On 
auscultation, — ver}-  indistinct  vesicular  murmur.  Occasionally,  a  moist 
rale,  like  subcrepitant  rattle  of  bronchitis.  Heart's  sounds  feeble  :  often 
cardiac  displacement.  Diseased  side  of  thorax  unduly  prominent  and 
rounded. 

Treatment.  Invigorating  diet,  with  attention  to  digestive  organs. 
Eest.  Warm  clothing.  Carbonate  of  ammonia,  361,  371.  Ammonia 
and  ether,  85,  364.  Lobelia  and  ether,  88.  Sumbul  and  hop,  869.  Qui- 
nine. 379.  Quinine  and  steel,  380.  Steel  and  pepsine,  394.  Cod-liver 
oil,  389.  Steel  and  cocoa-nut  oil,  391.  Phosphate  of  iron,  405.  Stra- 
monium smoking.  Easpail's  camphor  cigarettes.  Use  of  respirator. 
Warm  climate. 

2.  Interlobular  Emphysema. — Generally  due  to  sudden  rupture  of  air- 
cells  b}^  violent  strain.  Very  rarely  as.sociated  with  vesicular  emphy- 
sema. Can  only  be  relieved  by  antispasmodics.  When  extensive  may 
at  once  prove  fatal.  / 

EMPYEMA.— From  '^i-,  within;  -^;«y,  pus.  Synon.  Pyothora.r;  Hydro- 
thorax  Purulentiis. — The  formation  and  accumulation  of  pus  in  the  cavity 
of  the  pleura.  Some  physicians  speak  of  true  and  false  empyema:  the 
first  form  being  that  in  which  pus  is  secreted  by  pleura  in  consequence 
of  inflammation;  the  second,  that  in  which  pus  finds  its  way  into  thor- 
acic cavity  from  rupture  of  an  abscess  of  lung. — See  Pleurisy. 

ENDOCARDITIS. — From  "fvcJov,  within;  xapdia,  the  heart;  terminal 
-itis.  Synon.  Internal  Carditis. — Inflammation  of  the  transparent  and 
glistening  serous  membrane  which  lines  the  interior  of  the  heart,  and 
which  by  its  reduplications  assists  to  form  the  valves. — Endocarditis 
usually  associated  with  acute  rheumatism.  Endopericarditis  more  com- 
mon than  simple  endocarditis. 

Symptoms.  In  severe  forms,  a  sense  of  oppression  and  uneasiness  at 
prtecordial  region.  Fever.  Small  and  feeble  and  intermittent  pulse. 
Patient  prefers  to  lie  on  his  back ;  is  restless  and  anxious.  Cold  sweats. 
Oppressive  dyspnoea.  Jactitation.  Syncope. — When  morbid  action  is 
of  limited  extent,  or  of  subacute  character,  symptoms  milder  and  more 
obscure.  During  rheumatic  fever,  it  sometimes  occurs  without  being 
recognized;  though  its  power  is  manifested  by  the  structural  changes 
which  remain  after  apparent  recovery. — Endocarditis  of  left,  more  com- 
mon than  of  right  side  of  heart.  That  portion  of  membrane  covering 
valves  and  lining  orifices  most  frequently  attacked.  Seldom  directly 
fatal :  remote  effects  most  to  be  dreaded. 

Physical  signs :  Palpation  may  detect  a  vibratory  thrill.  Doubtful  if 
there  is  ever  increased  dulness  on  percussion,  owing  to  tumefaction  of 


106  ENDOMETRITIS. 

heart's  walls.  A  soft  bellows-murmur  detected  by  auscultation.  If 
murmur  be  systolic,  most  distinct  at  base  and  along  course  of  aorta,  and 
accompanied  with  small  pulse,  it  is  significant  of  aortic  obstruction ;  if 
systolic,  most  distinct  at  apex,  and  Math  irregular  pulse,  it  is  due  to 
mitral  regurgitant  disease.  A  diastolic  murmur,  most  distinct  from  centre 
of  sternum  upwards  towards  the  base,  with  a  jerking  pulse,  indicates 
aortic  regurgitation ;  while  a  diastolic  murmur,  most  distinct  from  fourth 
left  intercostal  space  downwards  towards  apex,  with  an  irregular  small 
pulse,  results  from  mitral  obstruction.  Pulmonary  systolic  and  diastolic 
murmurs,  infinitely  rare. 

Ternwiations :  Permanent  valvular  disease,  with  implication  of  heart's 
substance,  and  all  their  combined  consequences.  Systemic  loss  of  tonej 
impoverishment  of  blood  ;  obstruction  to  circulation  ;  drops}'.  Perhaps, 
8udden  death. — See  Embolism. 

Treatment.  Perfect  rest  of  body  and  mind.  Sulphate  of  magnesia, 
or  sulphate  of  soda,  if  there  be  constipation,  141,  144,  150,  152.  Car- 
bonate of  ammonia,  361,  362.  Aromatic  spirit  of  ammonia,  349.  Bicar- 
bonate of  potash  drink,  355.  Linseed  poultices  over  cardiac  region. 
Light  diet. 

Remedies  sometimes  employed :  Tartarated  antimony.  Calomel.  Mer- 
curial inunction.  Digitalis.  Opium.  Colchicum.  Bloodletting.  Leeches. 
Blisters. 

ENDOMETRITIS.— From  "E^8m,  within;  /^.ij^a,  the  womb;  terminal 
-itis.  Synon.  Uterine  Leucorrhcea ;  Uterine  Catarrh. — Catari'hal  or  croupy 
inflammation  of  mucous  membrane  lining  uterine  cavity. 

Symptoms.  Acute  variety :  Dry  hot  skin;  general  irritability ;  sallow 
complexion ;  loss  of  appetite.  Pain  about  lower  part  of  abdomen : 
sacrum,  groins,  inside  of  thighs.  Sense  of  heat  and  fulness  about  pelvis, 
bearing-down.  Frequent  micturition  :  urine  loaded  with  urates  or  uric 
acid.  Tenesmus  and  diarrhoea;  subsequenth'  constipation.  Ha>mor- 
rhoids.  Tendei'ness  of  ovaries  and  uterus  on  pressure.  Thick  and 
tenacious  discharge,  after  two  or  three  da^^s:  subsequently,  muco-puru- 
lent  secretion  tinged  with  blood,  imparting  a  greenish-yellow  or  yellow- 
ish-red stain  to  body  linen. 

Chronic  form  :  Euns  a  tedious  course.  Obstinate  dyspepsia;  flatu- 
lence; constipation;  mental  depression.  Wearj'ing  pains  about  sacrum, 
groins,  &c.  Discharge  of  abundant  glairy  mucus,  resembling  white  of 
egg  or  mucilage.  Increasing  debility.  Hysteincal  or  convulsive  affec- 
tions, severe  nausea,  tympanites,  tenderness  of  breasts,  and  menor- 
rhagia,  if  lining  of  fundus  be  involved. 

Treatment.  Acute  variety:  Eest  in  bed.  Diet  offish,  milk,  tea,  mu- 
cilaginous drinks.  Castor  oil.  Calomel  and  compound  jalap  powder, 
159.  Podoph^ilin,  160.  Warm  hip  baths.  \Yarm  water  vaginal  in- 
jections. Mercury  and  belladonna  pessary,  423.  Linseed  poultices  to 
lower  part  of  abdomen  and  vulva.  Four  or  six  leeches  to  lips  of  uterus. 
Avoidance  of  sexual  intercourse. 

Chronic  form :  Corrosive  sublimate,  27.  Green  iodide  of  mercury,  53. 
Eed  iodide  of  mercury,  54.  Donovan's  triple  solution,  51.  Iodide  of 
potassium,  31.  Mercury,  or  iodide  of  lead,  and  belladonna  pessaries, 
423.  Pepsine,  420.  Cod-liver  oil.  Leeches  to  labia  uteri,  or  scarifica- 
tions, only  if  there  be  congestion  and  no  tendency  to  menorrhagia. 
Division  of  os  uteri  with  hysterotome,  if  there  be  constriction.  Appli- 
cation of  solid  nitrate  of  silver  up  cervical  canal,  or  astringent  uterine 
pessaries  (424),  in  endometritis  limited  to  cervix.  Injection  of  tincture 
of  iodine,  but  only  after  dilatation  of  os  uteri  by  sponge-tents. — Animal 
food,  milk,  raw  eggs.     Avoidance  of  malt  liquors.     Gentle  exercise  in 


ENDOSTEITIS — ENTOZOA.  107 

open  air. — Subsequently, — Mineral  acids  with  bark,  376.  Quinine,  379. 

Nitro-hydroehloric  acid,  378.     Steel  and  pepsine,  31)4.  Phos|)hate  of 

iron,  405.     Mineral  waters  of  Spa,  467.     Honiburg,  491.  Carlsbad,  496. 
Marienbad,  497.     Kissingen,  493. 

ENDOSTEITIS. — From  "D^Sov,  within  :  oariov,  a  bone;  terminal  -itis. — 
Inflammation  of  medullary  membrane  lining  central  canal  of  long  bones, 
as  well  as  cells  of  flat  and  irregular  bones. — See  Osteomyelitis. 

ENTERITIS. — From  "B,zepi>v,  an  intestine  ;  terminal  -itis.  Synon. 
Intestinorum  Inflammatio ;  Ileocolitis;  Enterophlogosis. — Inflammation  of 
the  small  intestines  varies  much  in  severity.  Eesults  sometimes  very 
slight.  There  are  no  signs  by  which  the  morbid  action  can  be  positively 
diagnosed  as  existing  only  in  duodenum,  or  in  jejunum,  or  in  ileum. 
All  the  coats  of  the  bowel  ma}-  be  involved,  or  only  the  mucous  lining. 

Symptoms.  Rigors;  hot  skin;  thirst;  hard  and  frequent  pulse.  Ab- 
dominal pain,  especially  around  umbilicus;  increased  by  pressure. 
Nausea  and  vomiting.  Position  on  the  back  assumed,  so  as  to  relax 
abdominal  parietes.  Great  restlessness;  high  fever;  prostration;  anxiety 
of  countenance;  obstinate  constipation;  delirium.  Wiry  and  almost 
imperceptible  pulse.  Vomited  matters  highly  offensive  :  sometimes  ster- 
coraceous. 

Treatment.  Perfect  quiet  in  bed.  Opium  and  belladonna,  344. 
Enemata  of  warm  water,  to  empty  lower  part  of  intestines.  Ice  or 
cold  water.  Aconite.  Calomel.  Demulcent  drinks.  Broth;  beef  tea; 
farinaceous  substances;  milk.  Hot  linseed  poultices.  Fomentations. 
Application  of  belladonna  and  opium,  297.  Turpentine  stupes.  Sina- 
pisms. Blisters. —  Wliere  there  is  a  disposition  to  collapse:  Ammonia  and 
ether,  364.  Brandy  and  egg  mixture,  with  opium,  318.  Bi-andy  and 
ether,  367. — During  convalescence :  Ammonia  and  bark,  371.  Cod-liver 
oil.  Steel  and  cocoa-nut  oil,  391.  Steel  and  glycerine,  392.  Phosphate 
of  iron,  405.     Simple  animal  food;  milk;  raw  eggs. 

ENTOZOA. — From  ' Evroq,  within;  C"'"^',  an  animal. — The  parasitic 
animals  which  infest  the  human  body  are  very  numerous.  Helmin- 
thologists  are  well  acquainted  with  upwards  of  thirty  perfectly  distinct 
forms.     The  following  are  those  of  importance  : 

(1)  Fasciola  Hepatica. — Synon.  Distoma  liepaticum;  Liverfluke. — 
Of  the  order  Trematoda,  or  flukes.  Common  in  all  varieties  of  grazing 
cattle,  producing  the  Rot.  It  has  been  found  in  the  human  gall-bladder, 
&c.  Usually  rather  less  than  an  inch  in  length,  and  rather  more  than 
half  an  inch  in  breadth  ;  bod}^  flat,  covered  with  minute  spines,  of  an 
oval  form,  and  capable  of  contraction  like  that  of  a  leech :  has  an  ot*al 
and  a  ventral  sucker:  androgynous,  the  orifices  of  the  male  and  female 
organs  being  placed  side  by  side  near  the  ventral  sucker :  oviparous. 
Bile  forms  its  nourishment. 

(2)  Distoma  Lanceolatum. — Synon.  Fasciola  lanceolata. — This  hel- 
minth belonging  to  the  order  Trematoda,  is  smaller  than  the  preceding, 
and  less  common.  Bod}"  flat,  smooth,  and  of  a  lanceolate  form  :  androg- 
ynous: circular  oral  and  ventral  suckers.  Most  frequently  found  in 
liver  of  ox  :  only  three  cases  recorded  of  its  occurrence  in  human  sub- 
ject (Cobbold). 

(3)  Distoma  Ophthalmobium. — Synon.  Distoma  oculi-hn7nani. — Of  the 
order  Trematoda.  Four  specimens  have  been  found  in  the  eye  of  an 
infant  with  congenital  cataract  (Gescheidt).  Body  very  minute,  and  of 
a  lanceolate  oval  form  :  two  circular  suckers. 

(4j  Distoma  Crassum. — Synon.  Distoma  Buskii. — Of  the  order  Tre- 


108  ENTOZOA. 

matoda.  Body  varies  in  length  from  an  inch  and  a  half  to  three 
inches:  about  half  an  inch  in  breadth.  In  1843,  fourteen  of  these  flukes 
were  found  in  duodenum  of  a  Lascar  who  died  in  the  Dreadnought 
Hospital  ship  (Busk). 

(5)  DiSTOMA  Heterophyes. — A  very  small  trematode  helminth, 
scarcely  one  line  in  length.  Found  on  two  occasions  in  small  intestines 
of  boys  (Bilharz). 

(6)  DisTOMA  HAEMATOBIUM. — Synon.  Cryna'cophorus  hcematohivs ;  The- 
cosoma  hcemntohhim ;  Bilharzia  hcematobia. — A  cylindrical  trematode 
worm,  nearly  half  an  inch  in  length.  Males  and  females  distinct: 
former  the  largest,  and  having  on  under  surface  of  abdomen  a  longitu- 
dinal groove  (gynfficophoric  canal),  in  which  the  slender  female  is 
lodged  during  copulation. — See  Hcematozoa. 

(7)  Tetrastoma  Eenale. —  Has  an  oval  flattened  body,  about  five  lines 
long,  and  provided  with  four  suckers.  Said  to  be  found  in  the  tubuli 
uriniferi.     Very  little  knoMn  about  it. 

(8)  Hexathyridium  Pinguicola. — Synon.  Lingxiatula  pinguicola ; 
Polystoma  pinguicola. — A  flat  trematode.  about  eight  lines  in  length. 
Been  found  in  a  small  tumor  of  ovary  (Treutler). 

(9)  Hexathyridium  Yenarum. — Synon.  Polystoma  venarnm;  Lingua- 
tula  I'enarum. — vSee  Ho'matozoa. 

(10)  T^NiA  Solium. — Synon.  Tcenia  communis,  &c. — A  large  cestode 
helminth,  which  in  its  sexually-mature  or  strobile  condition  may  meas- 
ure from  twenty  to  thirty  feet  in  length  ;  breadth,  at  widest  part, 
nearly  half  an  inch.  Head  (scolex)  small  and  flattened,  provided  with 
a  projecting  papilla,  armed  with  a  double  circle  of  hooks,  and  with  four 
suckers:  the  neck  long  and  narrow,  continued  into  imperfect  segments 
(sexually  immature),  which  gradually  merge  into  distinct  segments 
(proglottides  or  sexually-mature  joints).  The  generative  apparatus  con- 
sists of  a  ramified  canal  or  ovarium  containing  the  ova,  and  of  a  minute 
spermatic  duct,  both  occupying  the  centre  of  each  proglottis.  Impreg- 
nation occurs  by  contact  of  one  proglottis  with  another.  The  cysti- 
eercus  cellulosae,  or  pork  measle,  is  the  larva  or  scolex  of  this  tape- 
worm.— See  Intestinal  Wor7ns. 

(11)  T^NiA  Mediocanellata. — A  cestode  worm,  attaining  a  greater 
length,  and  having  larger  segments  than  the  preceding.  Head  fur- 
nished with  large  sucking  discs,  but  destitute  of  a  rostellura  and  hook- 
apparatus.  The  "measles"  or  cj-sticerci  "udiich  produce  this  helminth 
are  found  in  the  muscles  of  cattle.  This  bookless  tapeworm  is  as  com- 
mon in  this  country  as  the  Taenia  solium,  for  which  it  is  often  mistaken 
(Cobbold). — See  Intestinal  Wonns. 

(12)  T^NiA  Marginata. — Synon.  Tcenia  ex  cysticercotenuicolli ;  Taenia 
tenuicolUs  ;  Tcenia  globosa. — Intests  man  only  in  the  immature  or  cj^sti- 
cercal  condition,  the  full-grown  tapeworm  (strobila)  being  found  in  dog 
and  wolf  (Cobbold).  The  larva  (Cysticercus  tenuicolUs)  only  been 
found  once  or  twice  in  human  body. 

(13)  Taenia  Echinococcus. — A  very  small  cestode  helminth,  infesting 
only  the  dog  and  wolf  Often  met  with  in  its  larval  condition  in  man, 
forming  the  well-known  hydatids  (echinococci,  or  acephalocysts). 
Hydatids  are  found  in  the  following  organs,  enumerated  according  to 
their  frequency  :  Liver;  subperitoneal  areolar  tissue  ;  omentum  ;  female 
breast;  muscles  of  heart;  brain;  spleen;  kidneys;  lungs;  bones,  espe- 
cially shaft  of  tibia. — See  Hepatic  Tumors. 

(14)  BoTHRiocEPHALus  Latus. — The  largest  cestode  helminth  ever 
met  with  in  human  subject;  sometimes  attaining  a  length  of  more 
than  twenty-five  feet,  and  a  breadth  of  nearly  an  inch  (CoblDold).  This 
broad  tapeworm  is  almost  peculiar  to  the  inhabitants  of  Switzerland, 


EXTOZOA.  109 

E-ussia,  and  Poland.     Each  joint  or  segment  possesses  its  own  ovary 
and  male  organs. 

(15)  AscARis  LuMBRicoiDES. — Sjnon.  Lumbricus  teres  homhiis. — A 
nematode  helminth,  in  size  and  appearance  like  the  common  earth 
worm.  Males  about  six  inches  long:  females,  double  this  length. — See 
Intestinal  Woryns. 

(16)  AscARis  Mystax. — A  nematode  worm,  especially  characterized 
by  the  presence  of  alaform  appendages,  one  being  placed  on  each  side 
of  the  head.  The  male  acquires  a  length  of  two  inches  and  a  half: 
female,  twice  as  long.  Very  common  in  the  cat.  In  a  few  instances  it 
has  been  found  in  human  intestine  (Cobbold). 

(17)  Tricocephalus  Dispar. — Synon.  Trichuris;  Ascaris  trichmra. — 
The  long  thread-worm  is  a  small  nematode  helminth,  usually  found  in 
caecum  and  large  intestines.  Male  measuring  about  eighteen  lines  in 
length,  female  reaching  two  inches. — See  Intestinal  Worms. 

(18)  Trichina  Spiralis. — See  Trichiniasis. 

(19)  Strongylus  Bronchialis. — Synon.  Filaria  hronchialis ;  Filaria 
lymphatica. — A  nematode  helminth  ;  the  male  measuring  al)Out  seven 
lines,  the  female  about  an  inch.  Has  been  found  in  the  human  bron- 
chial glands. 

(20)  EusTRONGYLUs  GiGAS. — Sj'uon.  Strongylus  gigas ;  Strongylus  re- 
nalis. — A  nematode  helminth;  the  male  attaining  a  length  often  to 
twelve  inches,  and  the  female  reaching  to  three  feet.  Not  very  un- 
common in  the  kidneys  and  ovarian  passages  of  animals,  especially  wea- 
sels. Eare  in  man.  Gives  rise  to  symptoms  like  those  of  renal  abscess 
or  renal  calculi. 

(21)  ScLEROSTOMA  DuoDENALE. — A  Small  nematode  worm  ;  the  males 
measure  one-third  of  an  inch  in  length,  the  females  being  rather  longer. 
Very  common  in  Egypt,  its  presence  in  the  small  intestines  of  the  na- 
tives giving  rise  to  severe  anaemia. 

(22)  OxYURis  Vermicularis.  —  Synon.  Ascaris  vermicularis.  —  This 
nematode  helminth  is  the  smallest  of  the  intestinal  worms.  Male 
about  three  lines  in  length ;  female  slightly  longer.  —  See  Intestinal 
Worms. 

(23)  Dracunculus  Medinensis. — Synon.  Filaria  Medinensis ;  Guinea- 
icorm. — See  Dracontiasis. 

(24)  Pentastoma  T^enioides. — One  of  the  family  of  Acaridae.  No 
structural  connection  with  true  helminths.  Adult  body,  lancet-shaped  ; 
flattened  at  ventral  surface;  marked  transversely  by  some  ninety  rings; 
four  feet  or  limbs;  head,  truncated;  general  surface  smooth,  but  in 
larval  condition  {Pentastoma  denticulatum)  furnished  with  many  rows  of 
sharp  spines.  Length  of  female,  three  to  four  inches;  of  male,  eight  to 
ten  lines.  Oviparous,  with  a  subsequent  metamorphosis.  In  sexually 
mature  state,  infests  nostrils  and  frontal  sinuses  of  dog  and  wolf;  in 
pupa  and  larva  state  found  in  human  abdominal  and  thoracic  cavities, 
though  it  has  not  been  met  with  in  this  country.  Does  not  give  rise  to 
any  functional  derangements  (Cobbold). 

(25)  Pentastoma  Constrictum. — About  half  an  inch  in  length,  and 
one  line  in  breadth.  Difters  from  larva  of  Pentastoma  taenioides  in  not 
having  spines.  The  cephalo-thorax  has  four  foot  claws;  the  elongated 
abdomen  is  marked  with  twenty-three  rings.  Has  been  found  in  the 
livers  of  negroes  at  Cairo  (Cobbold). 

(2G)  Pseudelminths. — The  following  so-called  worms  are  not  human 
parasites.  They  have  probably  been  introduced  into  the  excrements 
or  into  the  viscera  for  the  purpose  of  deception.  They  are, — Dactylius 
aculeatus;  Spiroptera  ho  minis ;  Diplosoma  crenatum  ;   Gordius  aquaticus, 


110  ENTROPION — EPILEPSY. 

or  common  hairworm  of  ditches,  about  a  foot  long,  extremely  slender, 
and  which  coils  itself  into  knots  (Cobbold). 
See  Eritozoa  in  the  Tabular  Synopsis. 

ENTROPION. — From  'jEv,  in  ;  rpiTttu,  to  turn.  Sjmon.  Inversio  Palpe- 
brarum;  Blepharelosis. — An  inversion  of  the  margins  of  the  eyelids. 
May  result  from  a  cicatrix  in  conjunctiva,  neglected  purulent  ophthal- 
mia, &c.  Removal  of  the  eyelashes  will  give  at  least  temporary  relief. 
Collodion  to  outside  of  lid:  alum  coagulum,  289. 

ENURESIS. — From  'Evoupiw,  to  urine  in  bed.  Synon.  Hyperuresis ; 
Incontinence  of  Urine. — May  be  associated  with  tendency  to  renal  dis- 
ease; disposition  to  gravel;  excess  of  uric  acid  in  urine;  stone  in  blad- 
der; loss  of  tone,  or  tumors,  of  walls  of  bladder;  irritation  of  thread- 
worms in  rectum  ;  haemorrhoids  and  prolapsus  ani ;  long  and  contracted 
foreskin;  stricture  of  urethra;  enlarged  prostate;  vascular  tumors  of 
female  ui^ethra;  ovarian  or  uterine  diseases  and  displacements;  par- 
alysis from  spinal  disease;  nervous  debility  ;  hysteria;  dyspepsia,  &c. 

Enuresis  very  common  in  young  children.  Its  occurrence  favored  b}^ 
free  use  of  fluids  during  after  part  of  day  ;  by  exposure  to  cold  in  night ; 
by  lying  on  back, — a  posture  unfavorable  to  retention  of  urine,  espe- 
cially when  natural  sensibility  of  mucous  membrane  of  neck  of  bladder 
is  increased. 

Can  usually  be  cured  by  making  child  almost  abstain  from  fluids  for 
three  or  four  hours  before  going  to  bed :  waking  him  to  empty  bladder 
twice  or  thrice  during  night :  tying  a  cotton  reel  over  spinal  column,  so 
that  when  he  turns  round  upon  his  back  he  may  be  awoke  :  giving 
strength  and  tone  to  system,  by  administration  of  the  tincture  of  per- 
ehloride  of  iron,  phosphate  of  iron,  cantharides  and  steel,  benzoic  acid, 
phosphate  of  zinc  and  belladonna,  cod-liver  oil,  &c.  Circumcision  will 
be  required,  if  there  be  a  long  prepuce  with  a  very  small  oritice.  In  in- 
veterate cases,  application  of  succession  of  small  blisters  over  sacrum. 
Where  bladder  is  very  irritable,  belladonna' plaster  over  loins  and  sac- 
rum: or  friction  with  diluted  belladonna  liniment.  Where  walls  of 
bladder  are  weak,  nux  vomica;  ergot  of  rye;  galvanism  to  lower  part 
of  abdomen  and  spine. 

EPILEPSY.  —  From  " Endaii^avm,  to  attack  unexpectedly.  Synon. 
Morbus  ComlfiaUs;  Falling  Sickness. — A  disease  presenting  these  promi- 
nent symptoms  :  Sudden  loss  of  consciousness  and  sensibility,  with  tonic 
convulsions  lasting  a  few  seconds,  and  followed  by  clonic  spasms  of 
voluntary  muscles.  Cessation  of  tit  succeeded  by  exhaustion  and  coma. 
Attack  recurs  at  intervals. — Hereditary  taint,  and  marriages  of  con- 
sanguinity, are  j^redisposing  causes. 

Warnings.  Premonitory  symjitoms  of  an  approaching  seizure  often 
not  experienced.  They  differ  in  duration  and  character.  Sometimes 
too  short  to  allow  sufferer  to  dismount  from  horseback,  or  remove  away 
from  fire,  or  lie  down  :  sometimes  many  minutes  or  hours  between  their 
occurrence  and  tit.  Spectral  illusions,  headache,  giddiness  (epileptic 
vertigo),  confusion  of  thought,  sense  of  fear,  and  that  peculiar  sensation 
— the  aura  epileptica — constitute  most  frequent  premonitory  symptoms. 
Epileptic  aura  differently  compai*ed  to  a  stream  of  cold  water,  a  current 
of  cold  or  warm  air,  sense  of  tingling,  creeping  of  insects;  the  feeling 
beginning  at  extremitj^  of  a  limb,  and  gradually  ascending  along  skin 
towards  head.     As  soon  as  the  aura  stops,  the  paroxysm  occurs. 

Symptoms.  Cadaverous  pallor  of  countenance,  with  utterance  of  a 
shriek  or  scream;  immediately  after  which  patient  falls  to  the  ground, 


EPILEPSY.  Ill 

and  frequently  on  bis  face,  senseless  and  violently  convulsed.  Severe 
burns,  fraetui^es,  dislocations,  &c.,  may  be  produced.  Convulsive  move- 
ments continue  violent:  usually  more  marked  on  one  side  of  body  tban 
on  tbe  other.  Gnashing  of  teeth.  Foaming  at  mouth;  protrusion  of 
tongue,  which  is  often  severely  bitten.  Eyes  partly  open  and  suffused  : 
eyeballs  rolling,  and  pupils  insensible  to  light.  Skin  cold  and  clammy. 
Perhaps  involuntar}'  micturition  and  defecation  :  vomiting.  Breathing 
laborious,  seems  about  to  be  suspended;  when  the  limbs  ai'e  stretched 
out,  a  deep  sigh  is  drawn,  and  attack  goes  oif.  Patient  left  insensible 
and  as  in  a  sound  sleep,  with  stertorous  breathing;  from  which  he  re- 
covers with  feeling  of  stupor  and  exhaustion  and  headache,  but  without 
any  knowledge  of  what  he  has  gone  through.  Some  hours  subsequently, 
small  ecchymoses,  like  fleabites,  often  to  be  detected  about  forehead 
and  throat  and  chest. 

Average  duration  of  fit  from  two  to  three  minutes.  Occasionally  said 
to  last  some  hours :  appearance  of  this  due  to  rapid  succession  of  seiz- 
ures.— the  status  epllqjticus.  Fit  may  be  very  slight  {petit  mal),  or  very 
severe  {grand  or  ha.ut  mal  of  the  French).  Former  often  only  consists 
of  giddiness,  loss  of  consciousness,  convulsions,  and  stupor,  and  is  all 
over  in  less  than  a  minute.  Seizures  recur  at  very  variable  intervals: 
often  happen  in  the  night,  and  for  a  time  without  being  suspected  b}' 
patient  or  friends.  Repetition  of  attacks  impairs  memory :  may  pro- 
duce cerebral  hemorrhage,  temporary  or  permanent  paralysis,  or  de- 
mentia and  idiocy. 

In  feigned  epilepsy,  the  impostor  does  not  fall  violently,  but  throws 
himself  down  deliberately  in  such  a  way  as  to  avoid  injury.  Eyes  are 
closed  ;  pupils  contract  to  stimulus  of  light;  tongue  is  not  bitten;  face 
is  red  instead  of  deadly  pale,  while  skin  is  hot  from  necessary  exertion  ; 
neither  urine  nor  fteces  are  voided.  Proposing  to  apply  actual  cauterj-, 
or  to  shave  the  head,  often  effects  a  speedy  cure.  Blowing  snuff  up  the 
nostril  changes  the  fit  into  one  of  sneezing. 

Treatment.  During  fit :  Patient  to  be  laid  on  a  large  bed,  or  on 
floor.  Air  to  be  freely  admitted  around  him.  Head  to  be  raised,  and 
all  tight  parts  of  dress  loosened.  A  piece  of  cork  or  soft  w^ood  to  be  in- 
troduced between  teeth  for  protection  of  tongue.  Cold  affusion  to  head 
sometimes  useful  Avhere  countenance  is  turgid.  Use  of  snuff,  so  as  to 
induce  sneezing. — Where  fit  is  preceded  by  epileptic  aura,  application 
of  ligature  just  above  region  from  which  sensation  starts,  may  prevent 
attack. 

During  interval :  Improvement  of  general  health  necessary.  Bromide 
of  potassium,  continued  for  a  long  time,  42.  Belladonna,  or  Atropia, 
326.  Hj^podermic  injection  of  atropine,  314.  Quinine,  379,  386.  Salts 
of  iron,  380,  390,  394,  405.  Salts  of  zinc,  410,  413,  414.  Hypophosphite 
of  soda  or  lime,  419.  Cod-liver  oil.  Henbane,  hop,  or  Indian  hemp,  if 
there  be  sleeplessness.  Nutritious  diet :  milk,  raw  eggs,  animal  food, 
wine  or  beer.  Cold  shower  bath.  Tepid  salt-water  sponge  bath.  Chap- 
man's ice  bags  to  spine.  Removal  of  stumps  or  decayed  teeth  :  or  of 
any  other  source  of  irritation,  as  worms,  &c. 

Remedies  sometimes  recommended  :  A  long-continued  course  of  corrosive 
sublimate.  Iodide  of  potassium.  Turpentine.  Camphor.  Valerian, 
Assafoetida.  Opium.  Digitalis.  Chloroform.  Naphtha.  Cajuput  oil. 
Nitrate  of  silver.  Ammonio-sulphate  of  copper.  Sulphate  of  copper. 
Ai'senic.  Juice  of  cotyledon  umbilicus.  Expressed  juice  of  galium  al- 
bum. Galvanism.  Stramonium.  Sumbul.  Oxalate  of  cerium.  Strych- 
nia in  small  tonic  doses.  Inhalation  of  oxygen.  Tracheotomy.  Caus- 
tics to  larynx.  Moxa,  or  actual  cautery,  to  nape  of  neck,  or  to  part 
whence  aura  starts.     Setons  or  issues  high  up  in  neck.     Repeated  blis- 


112  EPIPHORA — EPITHELIAL    CANCER. 

ters  over  upper  cervical  vertebrae.    Excision  of  clitoris.    Extirpation  of 
testicles. 

EPIPHOEA. — From  "E-i<fipo,  to  convey  to.  Synon.  Lachrymatio ; 
Weeping. — A  superabundant  secretion  of  tears,  so  tliat  tbey  run  over 
the  cheek.  Common  in  strumous  children.  May  be  due  to  foreign 
bodies.  To  be  distinguished  from  stillicidiwn  lachrymarum  owing  to 
closure  of  puncta  lachr3-malia,  or  to  obstruction  of  nasal  duct. 

EPIPHYTES. — From  ' E-\,  upon;  <fo-i'^,  a  plant.  Synon.  Plnjfopara- 
sites. — Microscopic  vegetable  growths,  belonging  to  the  class  Fungi 
Cryptogamia.  They  are  found  on  the  skin  and  raucous  membranes,  in 
the  stomach,  &c. 

The  chief  vegetable  parasites  are:  (1)  3Iicrosporon  furfur,  found  in 
Tinea  versicolor  or  chloasma.  (2)  Microsporon  mentdgrop/hytes,  in  Tinea 
sycosis.  (3)  Tricophyton  tonsurans,  in  ringworm.  (4)  Achorion  Schon- 
leinii,  in  Tinea  favosa  or  honeycomb  ringworm.  (5)  Microsporon  Audou- 
ini,  in  Tinea  decalvans.  (6)  Tricophyton  sporuloides,  in  Plica  Polonica. 
(7)  Oidium  albicans,  in  aphthae.  (8)  Sarcina  ventriculi,  in  some  stomach 
diseases.  (9)  Crypjtococcus  Cerevisioi  or  yeast  plant,  in  the  Htomaeh.  And 
(10)  Mycetoma  or  Chionyphe  Carteri,  in  Fungus  foot  of  India. — See  Tinea ; 
Fungus  Foot  of  India. 

EPISTAXIS. — From  'Entara^w,  to  drop  upon.  Synon.  Hcemorrhagia 
Nariiun;  Rkinorrhagia ;  Bleeding  at  the  ISJose. — Bleeding  from  the  nose  is 
very  common  in  early  life,  without  doing  anj^  harm.  But  it  frequently 
gives  rise  to  anxiety  when  it  occurs  in  advanced  life.  If  there  be  ten- 
denc}^  to  apoplexy,  or  if  patient  be  afflicted  with  heart-disease,  the  loss 
will  perhaps  prove  beneficial.  This  is  not  the  case  when  the  bleeding 
sets  in  during  progress  of  disorders  which  injure  quality  of  blood  ;  as  in 
renal  and  hepatic  diseases,  fever,  scurv}'.  purpura,  &c.  Exhausting  epis- 
taxis  may  be  immediate  cause  of  death  m  leucocythemia,  when  ap- 
proaching a  fatal  termination. 

Treatment.  Patient  to  be  seated  upright.  Collars  and  neckhand- 
kerchiefs  to  be  removed.  Holding  one  or  both  arms  above  the  head. 
Cold  to  neck  and  back,  or  over  nose  and  forehead  External  compres- 
sion of  nostril  with  finger.  Swabbing  nostril  with  perchloride  of  iron. 
Snuffing  of  alum,  powdered  matico  leaf,  tannin,  powdered  gum.  Injec- 
tions of  alum,  or  iron-alum,  or  tincture  of  perchloride  of  iron  in  water. 
Plugging  nostril  with  cotton-wool  saturated  with  an  astringent.  Styp- 
tic rods  of  tannin,  424.     Plugging  posterior  nares. 

Calomel.  Corrosive  sublimate,  27.  Gallic  acid,  103,  104.  Ammonio- 
sulphate  of  iron,  116.  Ergot  of  rye.  Mineral  acids  with  bark,  376. 
Tincture  of  perchloride  of  iron,  101.  Turpentine,  102.  Digitalis.  Mild 
laxatives,  142,  143.  Nitric  acid  and  tai^axacum,  147.  Nourishing  diet, 
potatoes ;  watercresses ;  orange  or  lemon  juice. 

EPITHELIAL  CANCER.— From  "E-ki,  upon  ;  and  dr^krj,  the  nipple. 
Properly,  therefore,  the  ej^idermis  of  the  nipple;  but  now  used  gen- 
erally for  the  layers  of  cells  forming  the  cuticle.  Synon.  Fpithelioma  ; 
Cancroid  of  the  Skin. — By  some  pathologists  regarded  not  as  a  form  of 
cancer,  but  as  a  disease  sui  generis,  consisting  of  an  infiltration  of  cells 
of  scaly  epithelium.  Hence  its  synonj'ms.  Eesembles  cancer  inasmuch 
as  it  returns  after  excision,  is  prone  to  incurable  ulceration,  affects  the 
i3'mphatics  seated  near  it,  and  destroys  the  patient.  Peculiar  in  being- 
little  liable  to  multiplication  in  internal  organs,  and  in  being,  apparently, 
produced  by  local  causes. — See  Cancer. 


EPIZOA ERYSIPELAS. 


11-- 


EPIZOA. — From  'isTrl,  upon  ;  and  Joiw,  an  animal.  Synon.  Ectopara- 
sites.— Animal  parasites  which  live  upon,  or  in  the  structure  of,  the  skin. 

The  epizoa  living  on  the  skin  are:  (1)  The  Louse  or  PefJiculus.  (2) 
Common  Flea  or  Pulex  irritans.  (3)  Chigoe  or  Jigger^  found  in  Guiana 
and  Brazil.  (4)  Ticks  or  Ixodes,  which  particularly  attach  themselves 
to  oxen,  sheep,  dogs,  wolves,  and  occasionally  to  the  human  body.  (5) 
Argades,  which  are  allied  to  the  Ticks,  and  are  met  with  in  parts  of 
Persia.  (6)  Common  Bed- Bug  or  Acanthia  lectularia.  And  (7)  the  Har- 
vest-Bug  or  Leptus  autumnaUs. — vSee  Phthiriasis,  and  F.  429. 

The  epizoa  found  in  the  skin  are  :  (1)  The  Itch  insect,  or  Acarus  scahiei, 
or  Sarcoptes  hominis.  —  See  Scabies.  And  (2)  Demodex  foUiculorum 
(Owen),  or  Acarus  foUiculorum  (Simon),  or  Pi.jnple  mite,  which  is  chiefly 
found  in  the  ducts  of  the  sebaceous  glands  of  the  altx?  of  the  nose. 

EQUINIA. — From  Equns,  a  horse.  A  severe  inflammatory  disease^ 
due  to  inoculation  with  morbid  fluids  generated  in  the  horse,  ass,  and 
mule. — See  Glanders. 

ERUPTIVE  FEVERS. — Continued  fevers,  Avith  an  eruption  super- 
added.—  See  Small-pox  ;  Coic-pox ;  Chicken-pox;  Measles;  Scarlet  fever ;. 
Rubeola;  Plague;  and  Erysipelas. 

The  principal  diseases  of  this  class  have  these  common  characters-: 
A  variable  amount  of  time  elapses  between  reception  of  poison  and  set- 
ting in  of  symptoms,  called  the  j^eriod  of  incubation;  the}^  are  accom- 
panied by  fever,  which  runs  a  defined  course;  are  attended  by  an  erup- 
tion, which  goes  through  a  regular  series  of  changes;  for  the  most  part 
aff'ect  every  individual  once,  and  once  only,  during  life;  and  the}"  arise 
from  specific  contagion.  Of  all  eruptive  fevers,  scarlatina  is  probably 
that  which  most  frequently  occurs  a  second  time. 

The  following  table  shows  the  period  of  incubation,  together  with 
date  of  eruption,  and  time  of  its  disappearance,  in  the  three  chief  erup- 
tive fevei's : 


Disease. 

Period  of  Incuba- 
tion. 

Eruption  appears. 

Eruption  fades. 

Measles,   .     .     . 
Scarlet  fever,     . 

Small-pox,    .     . 

10  to  14  days. 
4  to  6  days. 

12  days. 

On  4th  day  of  fever. 
On  2d  day  of  fever. 

On  2d  day  of  fever. 

On  7th  day  of  fever. 

On  .5th  day  of  fever. 

(  Scabs  form  on  9th  or 
\     10th  dav  of  fever,  and 
(    fall  ofl"  about  14th. 

ERYSIPELAS. — From 'jE'/oww,  to  draw;  r.ika^,  near, — expressive  of  the 
tendency  of  the  disease  to  spread.  According  to  German  lexicographers, 
from  'Epuffpo':,  red  ;  Tze?.k(i<;,  livid, — livid  redness.  Synon.  Saint  Anthony's 
Fire,  the  Hose. — A  diffused,  spreading,  inflammator}-  affection  of  the  skin, 
and  very  commonly  of  the  subcutaneous  areolar  tissue.  There  are  the 
general  phenomena  of  fever;  while  the  affected  part  becomes  of  a  deep 
red  color,  hot,  painful,  and  swollen. — It  is  a  miasmatic  disorder,  due  tO' 
absorption  of  a  specific  poison.  The  miasm  most  readily  generated  by 
the  assembling  together,  in  one  ward,  of  patients  with  unhealthy  dis- 
charges or  secretions.     Epidemic,  and  contagious. 

No  portion  of  the  surface  exempt  from  attacks.  Integuments  of  face 
and  head  most  commonly  the  sents  o?  idiopathic  erysipelas, — that  which 
arises  from  internal  causes ;  while  traumatic  erysipelas, — that  following 

8 


114  ERYTHEMA — EUSTACHIAN    TUBE    DISEASES. 

wounds, — commences  at  seat  of  injury.  In  simple  erysipelas,  inflamma- 
tion superficial ;  in  phlegmonous  form,  subcutaneous  areolar  tissue  in- 
volved. 

Symptoms.  A  period  of  incubation,  varying  from  three  to  seven  days. 
Chilliness,  rigors,  sore  throat,  fevei*.  and  constitutional  disturbance. 
Urine  sometimes  albuminous;  chlorides  diminished.  Cerebral  disturb- 
ance, delirium.  Nausea,  vomiting,  diarrhoea.  Swelling  of  the  part :  if 
of  face,  all  traces  of  natural  features  quite  lost. 

Death  may  occur  fi'om  extension  of  inflammation  to  brain  or  its  mem- 
branes. Chink  of  glottis  sometimes  becomes  closed  from  serous  ettusion. 
Failure  of  vital  powers.  Erysipelas  occurring  in  cases  of  diabetes,  or 
es])ecially  of  renal  disease  with  albuminuria,  are  almost  always  fatal. 
Mortality  in  England  averages  about  20i»0  annually.  Poison  of  ery- 
sipelas will  give  rise  to  puerperal  fever  in  lying-in  women. 

Treatment.  Confinement  to  bed  in  a  well-ventilated  room.  Light 
diet.  Cooling  drinks. — Castor  oil.  Aloes,  senna,  and  magnesia,  150. 
Ehubarb  and  blue  pill,  171.  Compound  rhubarb  powder,  165.  Carbonate 
of  ammonia,  o61,  371.  Tincture  of  perchloride  of  iron,  392.  Chlorate 
of  potash,  61.  Quinine.  Turpentine.  Colchicum.  Port  wine.  Ale  or 
stout.     Brandy.     Brandy  and  egg  mixture,  17. 

Locally:  Fomentations.  Poultices.  Inunction  with  lard.  Dusting 
with  flour  ;  finely-ground  rice  powder.  Collodion.  Boundary  lines  to 
be  drawn  on  sound  skin  with  nitrate  of  silver  or  tincture  of  iodine. 
Incisions  to  evacuate  pus,  or  to  relieve  great  tension. 

Infantile  erysipelas :  Vigorous  wet-nurse.  Good  milk.  Beef  tea. 
"White  wine  whey.     Wine  and  water.     Bark. 

ERYTHEMA. — From  'Epudaivio,  to  redden  or  cause  blushing.  Synon, 
Injiainmatory  Blush;  Efflorescence  Cutanee. — A  non-contagious  aflFection 
of  the  skin.  One  of  the  Exanthemata.  Characterized  by  slight  super- 
ficial red  patches,  irregularly  circumscribed,  of  variable  form  and 
extent.     Most  frequently  seen  on  face,  chest,  and  extremities. 

Varieties.  Erythema  fugax,  of  a  fleeting  nature,  and  generallj'due  to 
some  derangement  of  alimentarj'  canal.  Erythema  intertrigo,  sometimes 
produced  by  friction  between  folds  of  skin,  where  secretions  are  not 
removed  b}^  washing.  Erythema  pernio,  the  technical  name  of  that 
peculiar  inflammation  of  skin  constituting  an  unbroken  chilblain. 
Erythema  circinatum,  in  which  the  round  red  jjatches  are  sliglitly  raised, 
and  ring-shaped.  Not  of  uncommon  occurrence  in  acute  rheumatism. 
Erythema  Ixve,  which  is  developed  on  lower  extremities  when  they 
become  anasarcous.  Erythema  nodosum,  in  which  the  eruption  is  con- 
fined to  fore  part  of  leg,  taking  the  form  of  one  or  more  oval  raised 
patches,  resembling  nodes. 

Treatment.  Effervescing  citrate  of  magnesia.  Compound  rhubarb 
powder.  Pill  of  aloes  and  myrrh,  Colchicum.  Quinine.  Compound 
tincture  of  bark.  Mineral  acids.  Steel  wine.  Ammonio-citrate  of 
iron.  Pill  of  carbonate  of  iron.  Subacetate  of  lead  lotions.  Glycerine 
lotions.  Veratria  ointment,  if  there  be  pain.  Warm  water  or  vapor 
baths.  Warm  fomentations.  Elevation  of  limb.  Puncture  of  anasarcous 
limb.     Light  diet.     Cooling  drinks, — lemonade. 

EUSTACHIAN  TUBE  DISEASES.— This  tube  (first  described  by 
Eustachius).  by  which  the  tympanum  communicates  with  the  pharynx,  is 
about  two  inches  long.  Composed  partl}^  of  bone,  parti}'  of  fibro-carti- 
laginous  tissue.  It  affords  aa  entrance  for  air  into  tympanum  and  an 
.exit  for  mucus. 


EXOPHTHALMIC    GOITRE — EXPECTATION    OF   LIFE.  115 

1.  Obstruction  of  Tube. — Permanent  obstruction  produces  exhaustion 
of  air  in  tympanic  cavity:  consequently  a  pressure  inwards  of  niem- 
brani  tym])ani,  a  forcing  together  of  chain  of  bones,  pressure  on 
contents  of  labyrinth,  and  deafness.  Conditions  giving  rise  to  obstruc- 
tions are;  Thickening  of  mucous  membrane  of  laucial  ori^ce,  such  as 
often  coexists  with  chronic  enlargement  of  tonsils;  a  collection  of  viscid 
mucus,  or  stricture  of  middle  pai"t  of  tube;  and  thickening  of  mucous 
membrane,  stricture  of  bony  walls,  or  dejjosit  of  fibrine  at  tympanic 
opening. 

Symptoms.  The  entrance  of  air  into  tympanum,  during  act  of  degluti- 
tion, can  be  distinctly  heard  by  the  Otoscope, — an  elastic  tube,  eighteen 
inches  long,  having  its  ends  tipped  with  ivory.  One  end  being  inserted 
into  ear  of  patient,  and  the  other  into  that  of  the  surgeon,  the  patient 
is  directed  to  swallow  saliva  with  mouth  and  nose  closed.  If  tube  be 
pervious,  at  the  moment  the  patient  has  a  sensation  of  fulness  in  the 
ear,  practitioner  will  detect  a  faint  crackling  sound,  produced  by  slight 
movement  of  membrani  tympani.  Where  mucous  membrane  of  the 
tympanum  is  thickened,  a  gentle  flapping  sound  will  be  heard  instead 
of  faint  crackling.  If  the  otoscope  tail  to  reveal  any  sound  during 
deglutition,  if  no  sound  be  heard  when  a  forcible  attempt  at  expiration 
is  made  with  mouth  and  nose  tightly  closed,  and  if  no  other  cause  can 
be  found  for  dulness  of  hearing,  then  it  may  presumed  that  the  tube  is 
obstructed  (Toj'nbee). 

Treatment.  Attention  to  general  health.  Nourishing  diet;  warm 
clothing;  exercise  in  open  air;  sea  bathing.  Cod-liver  oil,  389.  Iodide 
of  iron,  82.  Iodide  of  potassium  and  bark,  31.  Corrosive  sublimate  in 
bark,  27.  If  tonsils  be  enlarged,  or  faucial  mucous  membrane  swollen, 
application  of  solid  nitrate  of  silver:  swabbing  with  tincture  of  iodine. 
Excision  of  tonsils.  Introduction  of  Eustachian  catheter.  Puncture  of 
membrani  tympani  in  irremediable  obstruction. 

2,  An  Open  Condition  of  Tube. — The  normal  condition  of  this  canal  is 
that  of  closure  by  apposition  of  its  walls.  It  acts  like  a  valve,  which  is 
opened  by  muscles  of  palate  and  pharynx  during  deglutition.  When 
permanently  open, — complaint  made  of  buzzing  and  other  noises  in  ear. 
Uneasiness  about  throat.  Occurs  during  attacks  of  catarrh  ;  in  irritable 
conditions  of  throat.     Cure  results  as  cause  subsides. 

» 
EXOPHTHALMIC  GOITRE.— From  '£|,  out ;  dwdaXijM,  the  eye.    Pro- 
trusion of  the  ej'eball  (proptosis  oculi),  accompanied  with  goitre. — See 
Bronchocele ;   Graves'  Disease. 

EXOPHTHALMOS.— From '£?,  out;  oipeaXiidq,  the  eye.  Synon.  Pro- 
cidentia Bulbi  Oculi;  Ophthalmocele ;  Protopsis  Oculi;  Goggle-eyed. — A 
protrusion  of  the  eyeball,  so  that  the  lids  cannot  cover  it.  Met  with  in 
some  forms  of  anajmia. — See  Graves'  Disease;  Ancemia. 

EXPECTATION  OF  LIFE.— By  this  term  is  meant,— the  mean  num- 
ber of  years  which,  at  any  given  age,  the  members  of  a  community, 
taken  one  with  another,  may  expect  to  live.  An  easy  rule  has  been 
established  for  determining  this  value:  The  expectation  of  life  is  equal 
to  two-thirds  of  the  difterence  between  the  age  of  the  individual  and 
eighty.  Thus,  a  man  is  20  years  old  ;  60  is  the  difference  between 
this  age  and  80 ;  two-thirds  of  60  are  40,  and  this  is  the  sum  of  his 
Expectation.  By  the  same  rule,  a  man  of  60  will  have  a  lien  on  life  for 
nearly  14  years;  a  child  of  5  for  50  years  (Willich).  The  results  thus 
obtained  correspond  very  closely  with  those  to  be  deduced  from  Dr. 


116  FALLOPIAN  TUBE  DROPSY — FEVERS. 

Farr's  English  Life  Table,  which  was  constructed  with  great  care  from 
an  immense  mass  of  records. 

FALLOPIAN  TUBE  DROPSY.— An  uncommon  aifection.  Fimbriated 
extremity  of  tube  together  with  uterine  orifice,  get  completely  obliter- 
ated in  consequence  of  chronic  inflammation;  the  portion  of  canal  be- 
tween the  openings  becoming  the  seat  of  an  accumulation  of  pus  or 
serous  fluid.  As  many  as  twenty-three  pints  of  fluid  have  been  found, 
under  these  circumstances.  Only  one  method  of  giving  relief, — punc- 
ture of  cyst  with  a  minute  trocar  and  canuJa  through  roof  of  vagina. 

FARCINOMA  OR  FARCY. — From  Farcio,  to  stufl'  or  cram. — A  severe 
contagious  disease ;  accompanied  with  a  pustular  eruption  or  small 
tumors  (Farcy-buds)  which  soon  suppurate,  and  malignant  fever.  Arises 
from  inoculation  with  morbid  matter  generated  in  the  horse,  ass,  or 
mule. — See  Glanders. 

FATTY  DEGENERATION. — The  designation  o?  fatty  degeneration,  or 
fatty  metamorphosis,  is  given  to  a  certain  class  of  cases  which  during  life 
are  marked  by  anaemia  with  great  prostration  ;  and  which,  after  death, 
are  found  to  be  distinguished  by  the  more  or  less  pertect  transformation 
into  fat  of  various  important  textures,  but  especially  of  muscular  fibres 
of  the  heart. 

There  is  no  connection  between  the  tendency  to  form  ftit  around 
organs,  or  the  production  of  obesity,  and  the  change  of  tissues  into  fat. 
In  foi'mer  case  there  is  a  condition  which  may  prove  preservative,  if 
confined  within  due  limits.  In  latter,  is  to  be  recognized  a  process  of 
decay  and  death,  the  result  of  some  defect  in  nutritive  functions. 

Amongst  the  causes  of  this  retrograde  metamorphosis  are  old  age, 
intemperance,  inactivity,  and  cessation  of  function.  Heart,  lungs,  brain, 
liver,  kidneys,  uterus,  and  arteries  may  sufter  from  it.  Atheroma  of  ar- 
terial walls  is  a  form  of  fatty  degeneration  ;  and  arcus  senilis  is  caused 
by  same  change  occurring  in  cornea.  When  important  organs  are  in- 
volved, it  may  lead  to  gradual,  or  sudden  death:  in  latter  case,  owing 
to  rupture  of  oi-gans. — See  Cardiac  Atrophy ;  Fatty  Degeneration  of  Kid- 
ney;  Hepatic  Degeneration. 

FEBRICULA. — Dim.  Febris,  a  fever.  Sj'non.  Ephemeral  Fever. — A 
mild  form  of  fever. — See  Simple  Continued  Fever. 

FEVERS. — From  Ferveo,  to  burn.  Synon.  Febris;  Pyrexia. — Fever 
may  be  defined  thus:  After  a  preliminary  stage  of  languor,  weakness, 
defective  appetite,  and  some  degree  of  chilliness  or  shivering,  there  is 
preteriMitural  heat  of  body,  increased  waste  of  tissue,  acceleration  of 
pulse,  great  muscular  debility,  and  disturbance  of  most  of  the  functions. 
This  morbid  state  accompanies  many  diseases  as  one  of  their  phenomena 
— symptomatic  fever;  but  under  certain  circumstances  we  meet  with  id- 
iopathic fevers,  which  are  probably  independent  of  any  local  lesion. 

Much  has  been  written  on  the  classification  of  fevers.  In  order  to  be 
as  clear  as  possible,  the  dift'erent  varieties  ma}'  be  arranged  on  the  fol- 
lowing plan : 

I.  Continued  Fever. 

1.  Simj/le  Fever,  or  Febricula. 

2.  Typhus  Fever. 

3.  Typhoid,  Enteric,  or  Pythogenic  Fever. 

4.  Relapsing,  or  Famine  Fever. 


FISTULA   IN   ANO — FLATULENCE.  117 

II.  Intermittent  Fever,  or  Ague. 

III.  Eemittent  P'ever. 

1.  Simple  Remittent  Fever. 

2.  Yellow  Fever. 

IV.  Eruptive  Fevers. 

1.  Small-pox,  or  Variola. 

2.  Cow-pox,  or  Vaccina. 

3.  Chicken-pox,  or  Varicella. 

4.  Measles,  or  Morbilli. 

5.  Scarlet  Fever,  or  Scarlatina. 

6.  Erysipelas. 

7.  Plague. 

For  further  information  concerning  any  particular  fever,  reference 
must  be  made  to  the  disease  as  it  is  arranged  in  alphabetical  order. 

FISTULA  IN  ANO. — From  Fistula,  a  pipe  or  reed ;  Anus,  the  funda- 
ment.— A  fistulous  passage  by  side  of  rectum,  the  result  of  abscess. — 
Two  forms  of  anal  fistula?:  (1)  Complete,  in  which  a  probe  can  be  intro- 
duced from  external  orifice  upwards  into  the  bowel.  (2)  Blind  external 
fistula,  where  mucous  coat  of  rectum  is  not  perforated. 

Symptoms.  External  aperture,  in  either  kind,  often  small  and  diflS- 
cult  to  find:  generally,  near  the  anus,  but  perhaps  one  or  two  inches 
distant;  may  be  concealed  in  a  furrow,  or  will  be  found  in  centre  of  a 
button-like  eminence.  Complete  fistula  most  annoying:  flatus,  intes- 
tinal mucus,  and  fluid  fseces  pass  along  its  tract,  causing  irritation,  and 
painful  spasmodic  contractions  of  sphincter. — Fistula  often  coexists 
with  phthisis:  probably  due  to  tubercular  inflammation  of  portion  of 
rectum,  followed  by  ulceration  and  perforation. 

Treatment.  Exceptional  cases  may  be  cured  by  attention  to  gen- 
eral health;  frequent  bathing  of  part  with  tepid  or  cold  water;  and 
daily  injection  along  sinus  of  iodine  lotion,  or  sulphate  of  zinc  lotion, 
&c.,  264,  269.  (renel-ally  it  is  necessary  to  divide  the  tissues  which  in- 
tervene between  the  external  and  internal  opening,  including  fibres  of 
sphincter  ani ;  first  clearing  out  the  bowels  with  aperients.  It  has 
been  recommended  to  effect  division  by  a  ligature,  to  be  tightened 
daily  until  parts  are  cut  through  ;  but  it  is  much  better  to  use  the 
knife,  pushing  it  through  the  mucous  membrane  of  the  bowel  if  thefe 
be  no  internal  opening.  Operation  not  forbidden  b}-  presence  of  tuber- 
cles in  lungs,  unless  the  deposit  be  abundant  or  case  otherwise  far  ad- 
vanced. 

FLAT  FOOT. — Synon.  Spurious  Valgus;  Splay  Foot.— A.  sinking  of 
the  tarsal  arch,  from  relaxation  of  the  supporting  ligaments.  Walk- 
ing is  rendered  awkward,  slow,  and  somewhat  painful.  In  confirmed 
cases,  lameness  and  deformity.  Occasionally  associated  with  talipes 
valgus  (see  Club  foot).  May  arise  from  constitutional  debilit}^  Avith  too 
much  standing.  Often  to  be  remedied,  in  slight  cases,  by  friction, 
bandaging,  and  improvement  of  general  health.  The  sole  of  boot  ought 
to  be  considerably  thicker  on  inner  than  outer  side.  An  apparatus  to 
support  ankle  and  invert  foot. 

FLATULENCE. — From  Flo,  to  blow  up.  Synon.  Tympanites;  Meteor- 
ism;  Drum  Belly;  Wind  Dropsy. — An  accumulation  of  gas  in  the  intes- 
tines occurs  as  an  idiopathic  disorder,  or  it  may  be  symptomatic  of  some 
other  aifection.     The  gas  is  generally  derived  from  the  decomposition 


118  FOREIGN    BODIES    IN   AIR-PASSAGES. 

of  imperfectly  digested  food ;  or  it  may  probably  be  a  secretion  from 
the  gastric  or  intestinal  raucous  membrane ;  or  it  will  be  merely  air  that 
has  been  swallowed.  In  the  eructation  or  belching  due  to  dyspepsia, 
the  gas  has  the  offensive  odor  of  sulphuretted  hydrogen. 

(1)  Idiopathic  form :  The  flatus  usually  most  abundant  a  few  hours 
after  food:  little  or  no  derangement  of  general  health.  Nervous  and 
hysterical  women  especially  liable  to  it.  Often  produced  by  green  vege- 
tables, ])ea  soup,  tea,  or  any  food  which  quickly  undergoes  fermenta- 
tion.—  To  be  cured  by :  Avoidance  of  vegetables,  soup,  beer,  tea.  Creasote, 
41.  Vegetable  charcoal,  98.  Mineral  acids  with  nux  vomica,  376.  Qui- 
nine and  nux  vomica,  387.  Strychnia  and  steel,  408.  Steel  and  pep- 
sine,  394.  Pepsine,  420.  In  tympanites  from  intestinal  atony  and  weak- 
ness of  abdominal  muscles,  electricity  very  useful. —  To  give  immediate 
relief  when  distress  from  ffatulence  is  urgent :  Carbonate  of  magnesia, 
opium,  and  ether,  62.  Ether  and  tincture  of  castor,  85.  Ammonia  and 
chloroform,  86.  Dill  water.  Caraway  water.  Assafoetida.  Cinnamon. 
Spirit  of  nitrous  ether.  Cajuput  oil.  Spirit  of  nutmeg.  Spirit  of  ju- 
niper. Compound  tincture  of  cardamoms.  Ammoniated  tincture  of 
valerian.  Tincture  of  ginger.  Hot  brandy  and  water  with  spice.  Pep- 
permint lozenges.  Castor  oil  and  rue  enema,  189.  Castor  oil  and  tur- 
jientine  enema,  190.    Turpentine  stupes.    Sinapisms.    Linseed  poultices. 

(2)  Symptomatic  flattdence :  An  accompaniment  of  indigestion  ;  inflam- 
matory disorders  of  stomach  or  bowels;  organic  diseases  of  liver;  peri- 
tonitis; typhoid  fever;  uterine  or  ovarian  irritation ;  gout,  &c. — Remedies: 
Of  a  variable  nature,  according  to  the  cause.  Enemata  of  turpentine 
and  rue,  189,  190.  If  quantity  of  air  be  excessive,  its  escape  may  be 
aided  by  passage  of  stomach-pump  tube  for  several  inches  up  rectum. 

FOREIGN  BODIES  IN  AIR-PASSAGES.— Foreign  matters  may  pass 
into  larj-nx,  ti-achea,  or  bronchi  of  children, — very  rarely  of  adults. 
They  may  enter  air-passages  from  within  the  body :  Worms  have  passed 
upwards  from  stomach,  b}'  oesophagus,  into  larynx.  Tubercular  deposit, 
or  pus,  now  and  tiien  makes  a  way  by  the  neck.  Retropharyngeal 
abscess  sometimes  bursts  into  larynx  or  trachea.  In  attempting  to 
repress  vomiting,  matters  from  the  stomach  have  entered  the  larynx. 
Portions  of  necrosed  bone  occasionally  work  a  passage  into  bronchi  or 
trachea. — Those  bodies  which  are  accidentally  introduced  from  \cithout 
are  often  remarkable  for  their  size,  considering  the  smallness  of  the 
chink  of  glottis.  The  most  common  are  portions  of  toys,  seeds  or  beans, 
fruit  stones,  buttons,  pins,  coins,  beads,  marbles,  pebbles,  nails,  fish- 
bones, masses  of  meat,  sugar-plums,  &c.  Animal  and  vegetable  sub- 
stances imbibe  moisture  and  swell :  sometimes  they  disintegrate  and  are 
expelled  piecemeal. 

Symptoms.  The  entrance  of  a  foreign  solid  body  from  without  usually 
occurs  during  a  sudden  and  strong  inspiration  :  it  at  once  causes  violent 
spasmodic  cough,  dj'spnoea,  a  sense  of  impending  suffocation,  perhaps 
immediate  death.  In  a  few  minutes,  symptoms  lessen  in  severity :  cough 
and  dyspnoea  return  at  intervals.  If  the  body  remain  in  larynx,  there 
will  be  harassing  and  suffocative  cough  :  loss  of  voice,  or  inability  to 
speak  above  a  whisper  :  probably  pain  in  swallowing:  tenderness:  noisy 
hissing  respiration,  Avith  more  or  less  dyspnoea.  If  it  descend  into 
trachea  it  is  seldom  stationary :  can  sometimes  be  felt  by  application  of 
hand  externally  to  rise  and  fall :  the  change  in  position  gives  rise  to 
severe  spasmodic  attacks  of  dyspnoea :  sometimes  a  flapping  or  valve- 
like sound,  owing  to  foreign  body  being  forced  against  rima  glottidis  in 
expiration.  The  substance  often  passes  on  into  one  of  the  bronchial 
tubes, — most  frequently  the  right,  being  directed  to  this  by  the  bron- 


FOREIGN   BODIES    IN    RECTUM — GALACTORRHEA.  119 

cliial  septum.  Auscultation  and  percussion  will  then  show  that  air  does 
not  enter  the  obstructed  lung  at  all,  or  only  incompletely:  diminution 
or  loss  of  resonance  and  of  respiratory  murmur.  The  fear  of  bronchitis 
and  pneumonia  to  be  remembered. 

When  fluids  enter  the  larynx  the}"  induce  a  sense  of  choking,  with 
convulsive  and  suffocative  cough,  which  usually  suffices  to  expel  them: 
if  very  abundant  they  may  cause  sudden  death. 

Treatment.  If  the  body  be  at  entrance  of  larynx,  or  between  the 
vocal  cords,  it  may  perhaps  be  seen  by  laryngoscope  and  seized  with 
polypus  forceps.  This  failing,  child  should  be  placed  with  head  down- 
wards, and  slapped  smartly  and  quickly  on  the  back.  Emetics  and 
sternutatories  can  be  tried  :  they  are  generally  useless. 

When  the  body  remains  in  larynx,  laryngotomy  should  be  performed 
as  early  as  possible:  when  it  has  descended  lower,  and  ]ierhaps  always 
in  young  children,  trachea  ought  to  be  opened.  The  substance  may  be 
ejected  through  glottis,  or  through  artificial  opening,  directly  the  latter 
is  made:  should  this  not  take  place,  patient's  body  must  be  inverted, 
and  a  few  smart  taps  made  to  dislodge  the  substance.  Inversion  rarely 
followed  by  bad  consequences,  because  patient  will  breathe  through 
artificial  opening:  hence  the  coin,  bean,  or  whatever  it  may  be,  will  not 
give  rise  to  that  severe  spasm  of  the  glottis  on  touching  it,  which  it 
would  otherwise  do.  Perhaps  this  spasm  of  glottis  might  be  overcome 
by  inhalation  of  chloroform,  without  opening  trachea.  If  tried,  the 
surgeon  should  be  prepared  to  perform  tracheotomy  immediately,  in 
case  of  necessity. — Where  extraneous  body  resists  all  efforts  to  remove 
it,  the  wound  in  the  trachea  should  be  kept  open  to  favor  expulsion 
subsequently.  When  operation  is  successful,  incision  should  be  imme- 
diately closed  by  strips  of  plaster  or  by  sutures.. 

FOREIGN  BODIES  IN  RECTUM.— May  consist  of:  (1)  Substances 
which  have  been  swallowed  ;  such  as  stones  of  fruit,  fish-bones,  coins,  &c. 
(2)  Concretions  formed  in  intestines,  having  a  gall-stone  or  some  mass 
of  indigestible  matter  as  a  nucleus.  (3)  Articles  forced  through  anus; 
as  pieces  of  wood,  syringe-pipes,  gallipots,  bottles,  ferrules,  &c. 

In  attempting  removal  of  substance,  force  to  be  avoided.  If  sphinc- 
ter be  contracted,  relaxation  should  be  procured  by  lubricating  with 
iodoform  (one  part  to  four  of  lard).  Chloroform  seldom  necessary.  In- 
durated faices  to  be  extracted  with  a  lithotomy  scoop  or  handle  of  spoon. 

FRAMBffiSIA. — From  Framboise,  a  raspberry.  Synon.  Anihracia  Bu- 
bula ;  Lepra  Fungifera;  Pian ;  Yaws. — A  tubercular  skin  disease,  said 
to  be  common  in  Africa,  parts  of  America,  and  West  Indies.  Without 
precursory  symptoms,  portions  of  skin  about  face,  scalp,  axillae,  or  gen- 
ital organs  are  found  covered  with  small  dusky-red  spots;  which  gradu- 
ally become  converted  into  larger  tubercles,  isolated  at  summits  but 
collected  together  at  bases,  and  resembling  raspberries  or  mulberries  in 
color  and  form.  Tubercles  generally  hard,  covered  with  dry  scales, 
sometimes  inflamed  If  inflammation  spreads,  ulceration  sets  in  ;  a  j^el- 
low  sanious  discharge  resulting,  which  forms  scabs.  Disease  continues 
for  years,  or  even  for  life. 

GALACTORRH(EA. — From  r«Aa,  milk ;  pim,  to  flow.  Synon.  Galac- 
topleurosis;  Superabundant  Secretion  cjf  Milk. — An  excessive  secretion  of 
milk  in  nursing  women.  Owing  to  this  excess,  the  milk  continually 
oozes  away:  several  pints  may  thus  escape  in  course  of  twenty-four 
hours,  keeping  patient's  clothing  wet,  and  weakening  her  system.  Hence 


120  GALL-STONES. 

result,  ana?mia;  hysteria;  dyspepsia;  low  spirits;  and  even  phthisis  or 
dropsy.     Milk  always  found  poor  in  quality,  after  a  time. 

Treatment.  Infjint  to  be  weaned.  Compression  of  breasts,  by  strap- 
ping with  belladonna  plaster.  Belladonna,  iodide  of  potassium,  eolchi- 
cum,  camphor,  &c.,  427.  Nourishing  food.  Removal  of  uterine  or 
ovarian  disease.     Iodide  of  lead  and  belladonna  pessaries,  423. 

GALL-STONES.  — Synon.  Chololithus ;  Biliary  Calculi.  — More  fre- 
quently formed  in  gall-bladder,  than  in  substance  of  liver — in  branches 
of  hepatic  duct.  Solitar}"  calculi  when  found  in  gall-bladder  are  globular 
or  oval  or  pear-shaped :  associated  stones  usually  have  numerous  polished 
facets,  the  result  of  pressure  and  mutual  attrition.  Gall-stones  formed 
in  branches  of  hepatic  duct  are  small,  rough  or  tuberculated,  and  of  a 
dark  color — like  black  pepper-corns.  Gritty  sand-like  deposits  (biliary 
gravel)  are  met  with  in  excretory  passages  of  liver ;  consisting  of  minute 
calculi,  or  of  a  powder  made  up  of  cholesterine  and  cholochrome. — 
Ingredients  of  gall-stones, — Cholesterine;  cholochrome  or  coloring  mat- 
ter; earthy  and  alkaline  salts — phosphate  and  carbonate  of  lime  and 
magnesia;  together  with  biliary  and  fatty  acids. 

Symptoms.  Small  calculi  in  branches  of  hepatic  duct  may  give  rise 
to  dull  pains  about  liver,  perhaps  shooting  to  shoulder;  to  symptoms  of 
intermittent  fever ;  gastric  disturbance  with  nausea.  As  they  usually 
only  cause  temporary  obstruction  to  flow  of  a  small  quantity  of  bile, 
there  is  no  jaundice. 

Hepatic  duct  rarely  blocked-up  b}^  a  concretion.  When  it  is,  symp- 
toms consist  of  intermittent  pains;  bilious  vomitings;  jaundice;  and 
enlargement  of  liver  owMng  to  escape  of  bile  from  all  the  ducts  being 
prevented.     Fatal  rupture  of  duct  has  occurred. 

Calculi  may  be  present  in  gall-bladder  without  producing  morbid 
derangements.  Earely,  they  set  up  catarrhal  or  plastic  inflammation; 
with  ])ains  about  epigastrium,  right  shoulder,  and  hip.  Loss  of  appe- 
tite; indigestion;  constipation.  Ulceration  and  perforation  have  oc- 
curi-ed. 

When  calculi  of  any  size  leave  the  bladder  and  enter  cystic  duct,  they 
cause  well-marked  symptoms — hepatic,  or  biliary,  or  gall-stone  colic.  Ex- 
cruciating pain.  Great  tenderness  of  right  hypochondriac  and  epigastric 
regions.  Nausea  and  vomiting.  Constipation  and  flatulence.  Perhaps 
rigors.  Slow  pulse. — If  stone  recede  into  bladder,  symptoms  cease :  if 
it  remain  impacted,  dropsy  of  gall-bladder  may  result,  and  perhaps 
ulceration  or  gangrene  of  duct:  if  it  be  forced  onwards  into  common 
duct,  there  is  a  sense  of  partial  relief:  though  pain  returns  as  duodenal 
orifice  is  reached.  If  common  duct  be  long  occluded,  jaundice  must 
ensue,  as  there  is  no  outlet  for  the  bile.  Where  obstruction  is  perma- 
nent, jaundice  increases;  liver  progressively  enlarges;  gall-bladder  gets 
much  distended.  Ultimately,  death  occurs;  unless  the  stone  be  forced 
into  bowel,  or  unless  it  induces  adhesive  inflammation  and  gets  into 
intestines  or  through  abdominal  walls,  after  ulcei-ation  and  perforation 
have  taken  place.  In  event  of  passing  into  intestines,  care  must  be 
taken  that  it  escapes  peranum;  otherwise  it  may  form  a  nucleus  for 
a  concretion,  and  ^jroduce  complete  obstruction  at  the  end  of  a  few 
months. 

Treatment.  Jlelief  of  biliary  colic:  Hot  water,  or  vapor,  or  air  bath. 
Fomentations  with  decoction  of  poppy-heads  and  chamomile  flowers. 
Linseed  poultices.  Poultices,  with  application  of  belladonna  and  opium, 
297. — Morphia,  chloroform,  and  Indian  hemp,  317.  Subcutaneous  injec- 
tion of  morphia,  314.  Opium  and  belladonna,  340,  344.  Opiate  ene- 
mata,  339.     Inhalation  of  chloroform,  or  ether,  or  of  a  combination  of 


GASTRALGIA — GASTRIC    ULCER.  121 

both.     Ice.     Copious  draughts  of  hot  water  containing  bicarbonate  of 
soda. 

Expulsion  of  calcuhis  and  prevention  of  further  formations :  Castor  oil. 
Seidlitz  powders,  169.  Phosphate  of  soda  and  aloes,  149.  Sulphate  and 
phosphate  of  soda,  148.  Pill  of  colocynth  and  hyoscyamus.  Carlsbad 
waters,  496.  Vichy,  479.  Eins,  486."  Eger,  498.  Eegulation  of  diet. 
Bloodletting  and  emetics  to  be  avoided.  Mixtures  of  ether  and  turpen- 
tine to  dissolve  calculi,  useless. 

GASTRALGIA.— From  rmrrip,  the  stomach ;  alyn-,  pain.  Synon. 
Dyspepsodynia;  Cardialgia ;  Heartburn. — An  unpleasant  burning  sensa- 
tion in  the  stomach  and  gullet,  coming  on  in  paroxysms.  A  common 
symptom  in  indigestion. 

Treatment.  White  bismuth,  65.  Carbonate  of  magnesia,  62.  Solu- 
tion of  potash,  69,  73.  Bicarbonate  of  soda.  Carbonate  of  ammonia. 
Saccharated  solution  of  lime,  14.  Lemon-juice.  Niti-ic  acid.  Dilute 
nitro-hydrochloric  acid,  378.  Hydrocyanic  acid,  86,  377.  Phosphoric 
acid.    Ammonio-citrate  of  iron,  401,  403.    Pepsine,  420. — See  Byspejma. 

GASTRIC  CANCER. — From  raffzijp,  the  stomach. — Generally  primary. 
May  be  of  scirrhous,  medullary,  or  colloid  variety.  Most  frequent 
seats, — pyloric  aperture ;  cardiac  orifice  j  space  along  lesser  curvature. 
More  common  in  men  than  women;  rare  before  fortieth  j^ear.  Few 
cases  survive  beyond  two  years  from  commencement  of  symptoms. 

Symptoms.  Pain  in  epigastrium,  of  a  burning,  lancinating,  or  gnawing 
character;  increased  by  food  and  pressure.  Retraction  of  abdominal 
wall.  Eructations  of  fetid  air.  Nausea:  frequent  vomiting  of  ingesta 
and  glairy  mucus,  of  bloudy  sanious  fluid,  of  dark  grumous  matter 
having  an  appearance  of  coflPee-grounds.  Constipation.  Debility. 
Emaciation,  which  becomes  extreme.  Pulsating  tumor,  when  mass  lies 
over  aorta  :  or  a  firm  painful  tumor  in  some  part  of  epigastric,  umbilical, 
or  hypochondriac  region.  Cancerous  cachexia. — Perforation  ma}-  occur, 
witli  escape  of  contents  of  stomach  into  peritoneum.  Or  perforation, 
with  communication  between  stomach  and  outside  of  abdomen  ;  between 
stomach  and  colon ;  between  stomach  and  duodenum ;  or  between 
stomach  and  pleural  cavities,  lungs,  or  pericardium. 

Treatment.  Opium  and  belladonna,  344.  Subcutaneous  injection  of 
morphia,  314.  Opiate  suppositories,  341.  Iodoform,  338.  Bismuth  and 
soda,  65.  Vegetable  charcoal.  Hydrochlorate  of  ammonia  (gr.  15  every 
two  hours),  to  relieve  nausea  and  pain.  Inhalation  of  small  quantities 
of  chloroform  or  ether,  313.  Cod-liver  oil. — Locally:  Wet  compress. 
Belladonna  and  opium,  297.  Linseed  poultices.  Hemlock  poultices. 
Fomentations.  Ointment  of  aconitia,  cautiously.  Ointment  of  atropia. — 
Diet:  Milk;  cream;  asses'  milk.  Raw  eggs.  Essence  of  beef,  3. 
Nutrient  enemata,  21,  22,  23. 

GASTRIC  ULCER. — From  /a-rrr;/),  the  stomach.  Sj-non.  Simple, 
Chronic,  or  Perforating  Ulcer  of  Stomach. — More  frequentl}-  in  women 
than  in  men,  and  in  poor  than  rich.  Very  x-are  before  puberty.  The 
ulcer  is  round  or  oval;  seldom  smaller  than  a  fourpenny  piece,  or  larger 
than  a  crown  piece  ;  and  mostly  seated  on  posterior  surface,  lesser  curv- 
ature, or  pyloric  pouch. — May  be  fatal  by  hemorrhage,  perforation,  or 
exhaustion. 

Symptoms.  Liable  to  some  variety.  Pain  in  epigastrium,  and  over 
lower  dorsal  vertebrte :  increased  by  food.  Violent  aortic  pulsations. 
Eructations  of  sour  fluid :  nausea  and  vomiting.     Loss  of  flesh.    Amen- 


122  GASTRITIS. 

orrhoea  in  yonnpj  women,  particularly  if  there  be  hemorrhage.  In  fiwor- 
able  cases  pains  diminish  as  ulcer  gradually  heals:  complete  recoveiy. 

Where  perforation  happens  :  Violent  pain,  spreading  from  epigastrium 
all  over  belly.  Tympanites.  Great  anxiety.  Eaj)idly  increasing  pros- 
tration.    Painless  collapse  in  a  few  hours;  death. 

Treatment.  Extract  of  opium  (gr.  1  every  six  or  eight  hours). 
Opium  and  belladonna,  344.  lienbane  and  Indian  hemp,  337.  Subcuta- 
neous injection  of  morphia,  314.  Bismuth  and  soda,  65.  Bismuth  and 
kino,  112.  Powder  of  kino  and  opium.  Nitrate  of  silver.  Oxide  of 
silver.  Oxalate  of  cerium.  Bicarbonate  of  potash,  ammonia,  and  aco- 
nite, 67.  Bromide  of  ammonium,  37.  Iodide  of  jjotassium.  Citrate  of 
ammonia  and  hydrocyanic  acid,  362.  Steel  and  ammonia,  401.  Steel 
and  citrate  of  potash,  403.  Iron  alum,  116.  Castor  oil.  Simple  ene- 
mata,  188. — Locally:  Hot  linseed  poultices.  Fomentations.  Turpen- 
tine stupes.  Sinapisms.  Ice  in  a  bladder. —  Great  care  as  regards  diet : 
Only  small  quantities  of  food  at  a  time.  Gruel,  or  arrowroot,  with  milk. 
Saccharated  solution  of  lime  and  milk,  14  Iced  milk.  Wenham  Lake 
ice.  In  severe  cases,  complete  rest  of  stomach:  nutrient  enemata,  21, 
23.  Subsequently, — White  tish.  Light  puddings.  Poultry.  Weak 
brandy  and  water.  Avoidance  of:  Sugar.  Beer.  Wine.  Coffee.  All 
indigestible  foods. — Great  caution  during  convalescence. 

GASTRITIS. — From  Faffzy-^p,  the  stomach  ;  terminal  -itis. — Several 
im))oi-tant  affections  of  the  stomach,  more  or  less  closely  connected  with 
intlamniation,  are  included  under  this  head. 

1.  Acute  Gastritis. — Synon.  Ivflammatio  Ventricidi. — Acute  inflamma- 
tion of  mucous  membrane  of  stomach  seldom  or  never  arises  idiopath- 
ically.  A  frequent  result  of  poisoning  by  mineral  acids,  caustic  alkalies, 
arsenic,  &c.  Sometimes  produced  by  swallowing  boiling  water,  exces- 
sive doses  of  antimony,  or  use  of  mustard  emetics. 

Symptoms.  In  gastritis  due  to  an  irritant  poison, — increasing  burning 
pain  in  epigastrium,  aggravated  by  pressure.  Distressing  nausea; 
violent  retchings.  Accelerated  pulse  and  bi'eathing.  Great  thirst; 
desire  for  cold  drinks,  which  are  vomited  immediately.  Constipation. 
Scanty  and  high-colored  urine.  Extreme  prostration  sets  in  quickly. 
Commonly  death  from  exhaustion. — In  exceptional  cases,  earl}-  symp- 
toms very  slight.  Disease  may  not  be  suspected  until  a  few  hours 
before  death. 

Treatment.  Purgative  enemata,  1S8.  Nutrient  enemata,  21,  22,  23. 
Free  sucking  of  ice.  Opium  and  belladonna,  344.  Opiate  suppositories, 
340.  Subcutaneous  iiijection  of  morphia,  314.  Linseed  poultices. 
Poppy-head  fomentations.  Mucilaginous  drinks;  iced  milk. — Avoid- 
ance of :  Emetics.     Stomach  pump. 

During  convalescence :  Great  care  as  to  diet.  Small  quantities  at  short 
intervals,  of  farinaceous  substances  and  broths.  Milk:  cream.  Eaw 
eggs.     Ice. 

2.  Chronic  Gastritis. — A  comparatively  mild  disorder,  unless  of  long 
duration.  May  produce  thickening  and  induration  of  coats  of  stomach, 
narrowing  of  p3'lorus,  or  ulceration  perhaps  going  on  to  perforation. 

Symptoms.  Anorexia.  Tenderness  at  epigastrium  and  sternum. 
Pain  and  sickness  after  meals.  Slowness  of  digestion.  Gastrodynia. 
Pyrosis.     Disordered  bowels. 

Treatment.  Low  diet.  Iced  water,  or  ice.  Eemoval  of  cause. — See 
Dysfepsia. 

3.  Gastric    Catarrh.  —  Catarrhal   affections  of  stomach   when   slight 


GASTRITIS.  123 

usually  spoken  of  as  "  bilious  attacks." — SymjAoms  are  those  of  indiges- 
tion :  furred  tongue,  oppression  at  epigastrium,  vomiting  of  bile,  giddi- 
ness, "sick  headache."  —  Rernedij-s  consists  of  rhubarb,  ipecacuanha, 
mercury  and  chalk,  Seidlitz  powders.     Meagre  diet.     Soda  water.    Ice. 

Chronic  catarrh  or  mucous  flux  may  succeed  a  bilious  attack,  or  arise 
independently.  Often  coexists  with  chronic  bronchitis,  hooping-cough, 
plithisis,  and  pulmonary  emphysema.  There  is  congestion  of  capillary 
gastric  vessels,  with  excessive  secretion  of  glairy  mucus. — Symptoms  are 
those  of  indigestion.  Often  a  craving  for  food;  only  a  small  quantity 
can  be  taken  without  sense  of  oppression,  vomiting,  &c. — Remedies  are 
such  as  restrain  secretion  of  mucus  and  restore  tone  of  stomach.  Sul- 
phite of  soda,  48.  Bismuth,  65,  112.  Kino  and  logwood,  108.  Iron 
alum,  116.  Tannin  lozenges.  Aromatic  sulphuric  acid  Calomel  (gr.  5), 
if  there  be  constipation.  Milk  and  saccharated  solution  of  lime,  14. 
Arrowroot.  Gruel.  Bread  and  milk.  White  fish.  Poultry.  Sherry  and 
water.     Soda  water. 

Severe  examples  of  gastric  catarrh  sometimes  spoken  of  as  "  gastric 
fevers." — Chief  symptoyns  are  heat  of  skin;  quick  and  full  pulse;  vomit- 
ing, with  epigastric  pain;  scanty  urine  loaded  with  lithates.  Super- 
ficial ulceration  of  mucous  coat  may  result. — Remedies  are  rest,  low  diet, 
demulcent  drinks,  mild  aperients,  effervescing  salines.  An  emetic  of 
ipecacuanha  at  commencement.  Hot  fomentations.  Poultices.  Tur- 
pentine stupes. 

4.  Induration  of  Pylorus.  —  Synon.  Fibroid  Infiltration  of  Pylorus; 
Plastic  Li  nit  is  ;  Cirrhotic  Inflammation. — Consists  of  an  abnormal  devel- 
opment of  fibrous  tissue  in  submucous  areolar  membrane  about  pyloric 
portion  of  stomach.  As  a  consequence  there  is  stricture,  perhaps  with 
dilatation  of  stomach  and  hypertrophy  of  muscular  coat. 

Symptoms.  Eesemble  those  produced  by  cancer,  save  that  they  ex- 
tend over  a  longer  space  of  time.  Emaciation  and  progressive  debility. 
Pyrosis.  Sickness.  Constipation.  Mental  depression.  Appetite  may 
be  ravenous  :  a  large  meal  causes  great  suffering,  as  food  tries  to  pass 
through  pylorus.  Vomited  matters  may  look  like  yeast,  and  contain 
sarcinse  or  torulee:  often  consist  only  of  partially  digested  food.  In- 
durated p3dorus  can  be  felt,  like  a  tumor,  through  abdominal  walls. 
Aortic  pulsation.  Disturbed  sleep.  Prostration.  Death  from  inani- 
tion ;  though  by  strict  attention  to  diet,  life  may  be  prolonged  for  some 
years. 

Treatment.  Iodide  of  potassium.  Iodide  of  ammonium.  Hydro- 
chlorate  of  ammonia.  Liquor  calcii  chloridi  (Phar.  Dub.).  Opium. 
Belladonna.  Belladonna  plaster.  Wet  compress.  Cod-liver  oil.  Liquid 
food, — milk,  cream,  raw  eggs,  soups,  wine.  Nutrient  enemata.  AVarm 
clothing. 

5.  Dilatation  of  Stomach.—  Generally  due  to  some  affection  of  pylorus 
causing  contraction,  so  that  food  is  impeded  from  passing  into  duode- 
num. Dilatation  goes  on  slowly  and  steadily,  until  stomach  comes  to 
occupy  a  large  portion  of  abdominal  cavity. 

Symptoms.  Stomach-cramp,  heai-tburn,  water-brash,  flatulence,  con- 
stipation, and  sometimes  attacks  of  vomiting.  Appetite  may  be  vora- 
cious. Where  there  is  vomiting,  ejected  matters  are  large  in  quantity, 
intensely  acid,  often  resemble  yeast :  microscopically  examined,  vSarcinse 
ventriculi  are  found,  and  sometimes  the  j^east  fungus — Torulse  cerevisia^. 
These  vegetable  organisms  probably  result  from  long  detention  of  food 
in  stomach. 

Treatment.  Eegulation  of  diet:  unfermented  or  aerkted  bread. 
Food  not  to  be  too  limited,  where  appetite  is  large.     The  author  has 


124  GASTRO-COLIC    FISTULA — GLAUCOMA. 

known  suicide  committed  from  not  allowing  sufficient  food  to  relieve 
tlie  hunger. — Formation  of  parasites  to  be  checked  by  sulphite  of  soda, 
48.  Sulphite  of  potash.  Hyposulphite  of  soda. — For  relief  of  other 
8y mptoms J  Bee  Gastralgia ;   Gastrodynia  ;  Pyrosis;  Dysjyepsia. 

GASTRO-COLIC  FISTULA.— A  communication  between  the  stomach 
and  colon  takes  place  with  greater  frequency,  than  between  stomach 
and  duodenum.  More  commonly  due  to  cancerous  than  simple  ulcera- 
tion. Stomach  and  colon  not  always  closely  adherent :  a  cavity  may 
intervene,  as  if  a  mass  of  cancer  or  tubercle  had  connected  the  two 
viscera,  and  been  gradually  hollowed  out. — The  symptoms  are  chiefly 
fecal  vomiting,  and  expulsion  of  undigested  food  with  the  stools. 

GASTRO- CUTANEOUS  FISTULA.— A  communication  between  the 
stomach  and  outside  of  abdomen.  May  result  from  suppuration  in  ab- 
dominal wall;  wounds;  from  long-continued  pressure,  voluntaril}' pro- 
duced by  hysterical  women  ;  or  from  simple  or  malignant  perforating 
ulcer  of  stomach,  this^viscus  first  contracting  adhesions  with  perito- 
neum. In  either  case,  it  is  almost  impossible  to  close  the  opening.  A 
plug  must  be  worn  to  prevent  escape  of  contents  of  stomach. 

GASTRODYNIA. — From  FafTTr^p,  the  stomach;  odu'^r^,  anguish  or  pain. 
Svnon.  Spd sinus  Ventriculi ;  Stomachalgia  ;  Cramp  in  the  Stomach. — May 
occur  in  connection  with  organic  disease  of  stomach,  or  from  simple  in- 
digestion. 

Treatment.  White  bismuth.  Oxide  of  silver.  Oxalate  of  cerium. 
Morphia.  Hydrocyanic  acid.  Wood  charcoal.  Creasote.  Sinapisms. 
Linseed  poultices.     Wet  compress. — See  Dyspepsia ;  Pyrosis. 

GENERAL  PARESIS. — From  Ildpem^,  want  of  strength,  from  -rafiir^nt, 
to  relax.     Synon.  Progressive  Paralysis  of  the  Insane. — See  Insanitij. 

GLANDERS.  —  Synon.  Equinia ;  Farcinoma ;  Farcy. — A  malignant 
febrile  and  contagious  disease:  due  to  a  specific  poison  received  from  a 
glandered  horse,  ass.  or  mule.  Glanders  and  farcy  are  essentially  iden- 
tical, both  having  their  origin  in  the  same  poison.  But  when  the  effects 
of  the  morbid  agent  ai-e  especially  manifested  in  the  nasal  cavities,  the 
disease  is  known  as  glanders;  while,  when  the  lymphatic  system  suffers, 
it  is  Qtd\e&  farcy. 

Treatment.  Prophylactic :  Cauterization  of  inoculated  tissue.  Sul- 
phite of  soda  or  magnesia,  48. 

Curative:  Sulphurous  acid.  Sulphite  of  soda  or  magnesia,  48.  Iodide 
of  potassium,  grs.  10  to  15  thrice  daily.  Bark.  Quinine.  Arsenic. 
Strychnia.  Carbonate  of  ammonia.  Disinfectant  washes  to  nostrils 
and  ulcers.  Creasote  injections.  Vapor  baths.  Stimulants.  !Nourish- 
ing  food.     Pure  air.     Abscesses  to  be  opened. 

GLAUCOMA. — From  rXau/.6^,  sky-blue. — A  term  formerly  applied  to 
opacity  of  the  lens.  Now  used  arbitrarily  to  denote  a  form  of  blindness 
attended  with  disorganization  of  the  various  tissues  of  the  eyeball.  The 
symptoms  are  the  result  of  excessive  intraocular  pressure,  this  being 
due  to  an  increase  in  quantity  and  firmness  of  the  vitreous  humor 
(Hulke).  Glaucoma  peculiar  to  middle  life  and  old  age  :  its  occurrence 
sometimes  foreshadowed  by  quickly  increasing  presbyopia. 

Symptoms.  The  disease  may  be  acute;  when  the  glaucomatous 
changes  take  place  rapidly,  and  quickly  end  in  loss  of  vision.  Attack 
perhaps  commences  suddenly  during  night,  with  severe  throbbing  pain 


GLOSSITIS — GONORRHCEA.  125 

in  one  eye  and  temple.  Pain  continues  ;  on  following  morning,  scle- 
rotic found  discolored  and  congested.  Iris  becomes  of  a  dusk}-  hue,  and 
motionless:  cornea  gets  dim:  pupil  widely  dilated,  and  sometimes  of  an 
irregular  oval  shape  :  eyeball  felt  to  be  unnaturally  hard.  Sometimes 
complaint  made  of  bright  flashes  of  light  darting  before  the  eye.  Occa- 
sionally there  is  slight  temporary  improvement,  though  blindness 
subsequently  results.  Both  eyes  affected;  disease  usually  commences 
in  one  a  few  days  befoi'C  the  other. 

I?i  c/«'on«c  glaucoma  same  symptoms;  but  they  come  on  insidiously, 
with  much  less  pain.  Morbid  changes  spread  over  many  months. 
Their  sequence  seems  to  be  as  follows:  First,  in  retina  and  choroid; 
going  on,  perhaps,  to  serous  effusion  between  these  two  coats,  which 
causes  a  bulging  forwards  of  lens  and  iris,  by  pressing  from  behind  upon 
vitreous  body.  Then,  congestion  and  inflammation  of  iris  and  cornea. 
Last  of  all,  opacity  of  lens,  as  a  consequence  of  its  deranged  nutrition 
(Dixon). 

Opthalmoscope  usually  shows  extravasations  of  blood  in  retina  and 
choroid;  serous  effusion  between  retina  and  choroid,  retina  appearing 
as  if  raised  into  folds ;  small  clots  in  vitreous  humor;  and  an  excava- 
tion of  optic  nerve  entrance,  with  pulsation  of  arteria  centralis  retin®. 

Treatment.  Bleeding,  blistering,  and  mercury  have  invariably  done 
great  harm.  All  that  the  physician  can  do  is  to  improve  the  general 
health.  Whether  the  surgeon  can  best  reduce  the  excessive  tension  of 
the  eyeball  in  acute  cases,  by  iridectomy,  or  simply  by  evacuating  the 
aqueous  humor,  is  a  disputed  point. 

GLOSSITIS. — From  Flwnffa,  the  tongue,  terminal  -His.  Synon.  Inflam- 
matio  Linguce;  Inflammation  of  the  Tongue. — See  Tongue  Diseases. 

GLUCOHjEMIA. — From  n.uxu<;^  sweet;  ai/m,  blood.     Sweet  blood. — 

See  Diabetes  Mellitus. 

GLUCOSURIA. — From  D.uxhq,  sweet;  uupov,  the  urine.     Sweet  urine. 

See  Diabetes  Mellitus. 

GOITRE. — Perhaps  from  Guttu?',  the  throat.     See  Broitchocele. 

GONORRH(EA. — From  Avtj,  semen ;  piio^  to  flow.  Improperly  used 
to  signify  an  inflammation  more  or  less  acute  of  one  or  more  portions 
of  the  genito-urinaiy  passages,  accompanied  with  a  muco-purulent  dis- 
charge.    Synon.  The  Clap. 

1.  Gonorrhoea  in  Male. — Inflammation  of  the  mucous  membrane  of 
the  urethra, — generally  of  the  anterior  portion.  It  is  attended  with 
the  flow  of  a  contagious  purulent  or  muco-purulent  fluid. 

Symptoms.  About  third  day  from  exposure  to  contagion,  heat  and 
itching  of  glans  penis.  Fulness  and  redness  of  urethral  orifice.  Milky 
purulent  discharge,  which  becomes  muco-purulent.  Scalding.  Pain  in 
groins,  irritability  of  bladder,  weight  and  dragging  pain  about  testicles. 

Complications:  Painful  erections  or  chordee.  Balanitis.  Hemorrhage 
from  urethra.  Eetention  of  urine.  Abscess.  Prostatitis.  Cystitis. 
Orchitis.     Gonorrhoeal  ophthalmia.     Gonorrhoeal  rheumatism. 

Treatment.  Balsam  of  copaiba  and  cubeb  pepper:  very  inefficient, 
nauseous,  apt  to  derange  stomach  and  to  produce  skin  eruptions.  Mer- 
cur}^,  turpentine,  creasote,  nitrate  of  potash,  ergot  of  rye,  &c.,  worse  than 
useless.  Oil  of  yellow  sandalwood  (Sirium  myrtifolium)  and  Gurjun 
balsam  or  wood  oil  (product  of  the  Dipterocarpus  turbinatus)  have  been 
recommended. 


126  GOUT. 

Abortive  trenfment:  In  early  stages  always  very  dangerous.  It  consists 
of  injections  of  nitrate  of  silver  (grs.  5 — 10  to  fl.  oz.),  active  purgatives, 
perfect  rest,  abstinence  from  stimulating  food  and  drinks,  and  hot 
bathing ;  followed  by  mild  injections  of  subacetate  of  lead,  and  gentle 
aperients. 

In  ordinary  cases :  Mild  aperients.  Moderate  rest.  Diet  free  from 
salt  meats,  pastry,  cheese,  coffee,  wine,  beer,  and  spirits.  Injections 
— from  1  to  3  grs.  to  the  fl.  oz — of  alum,  acetate  of  lead,  sulphate  of 
zinc,  chloride  of  zinc,  acetate  of  zinc,  nitrate  of  silver,  sulphate  of 
copper,  or  sulphate  of  iron.  Testicles  to  be  supported  by  a  suspensory 
bandage. 

Astringent  sticks  or  suppositories  made  with  cocoa  butter  and  alum 
or  sulphate  of  zinc  or  tannic  acid,  so  as  to  be  introduced  into  urethra. 
Strips  of  lint  or  linen  moistened  with  an  astringent  solution,  passed 
down  urethra  for  two  inches.  Cauterization  of  urethra  with  nitrate  of 
silver.  Copaiba  mixed  with  urine  as  an  injection?  Copaiba  enemata 
and  suppositories? 

For  relief  of  scalding:  Warm  baths.  Liquor  potassse  in  camphor 
water.  Opium.  Drinking  freelj^  of  tea  witii  milk,  or  of  plain  water. 
Demulcent  drinks  useless,  except  as  vehicles  for  water. 

For  relief  of  chordee :  Camphor  (grs.  5)  and  belladonna  (gr.  2)  in  a 
pill  at  bedtime.  Spirit  of  camphor  in  drachm  doses.  Sleeping  on  a 
mattress,  without  much  covering;  towel  with  a  knot  over  spine,  or  a 
cotton  reel,  to  prevent  lying  on  the  back. 

For  retention  of  urine:  Warm  bath  and  opiate  suppository,  before  re- 
sorting to  catheter. 

For  hemorrhage  from  urethra:  Application  of  ice.  Pressure  by  intro- 
duction of  a  large  bougie.     Pressure  externally,  by  pad  and  bandage. 

2.  Chronic  Gonorrhoea  or  Gleet. — Transparent  mucous  discharge.  No 
scalding  nor  pain.  Frequent  calls  to  pass  urine,  when  the  prostate  or 
the  neck  of  the  bladder  is  irritable.     Pain  in  pei-ineum. 

Treatment.  Temperate  mode  of  living.  Attention  to  digestive  or- 
gans. If  there  be  an  organic  or  permanent  stricture,  employ  dilatation, 
Ibrcible  rupture  or  incision. 

Where  patches  of  the  urethra  are  contracted  and  over  sensitive,  use 
bougies  smeai*ed  with  some  astringent  ointment.  Solid  nitrate  of  silver, 
by  means  of  Lallemand's  porte  caustique.  Astringent  injections.  Sus- 
pensory bandage  for  testicles. 

If  there  be  irritation  about  prostate  or  neck  of  bladder,  avoid  bougies 
and  injections.  Employ  hot  baths,  warm  bathing  of  penis  and  peri- 
neum, opiate  suppositories,  and  application  of  extract  of  belladonna  to 
perineum.  Infusions  of  uva  ursi,  pareira,  or  bucco.  Iodide  of  potassium, 
'6\.  Painting  under  surface  of  urethra  and  perineum  with  tincture  of 
iodine.     Application  of  a  blister  to  penis  for  one  or  two  hours. 

Where  there  is  constitutional  debility, — Phosphoric  acid  and  bark, 
376.  Gallic  acid,  103.  Iron-alum,  116.  Steel  and  cantharides,  4U0.  Nux 
vomica.     Cod-liver  oil.     Sea  bathing.     Nourishing  diet. 

3.  Gonorrhoea  in  Female. — Consists  of  acute  or  chronic  inflammation 
of  urethra,  vulva,  vagina,  or  canal  of  cervix  uteri.  Not  to  be  distin- 
guished from  inflammations  due  to  other  causes  than  impure  sexual  in- 
tercourse. 

Treatment.  Hot  hip  baths.  Yaginal  injections  of  warm  water.  Mild 
aperients.  Rest.  Low  diet.  Astringent  injections,  425.  Medicated 
pessaries,  423.     Solid  nitrate  of  silver. 

GOUT. — From  the  Fr.  Goutte,  a  drop ;  because  it  was  thought-  to  be 
produced  by  a  humor  which  fell  goutte  d  goutte  into  the  joints. — May  be 


GRAVEDO.  127 

defined  as  a  specific  inflammation,  having  a  constitutional  origin,  and 
being  much  favored  by  hereditary  taint.  It  is  accompanied  by  great 
pain  and  swelling  of  the  affec^ted  joint,  fever  with  general  disturbance, 
and  especially  by  some  disorder  of  the  digestive  organs.  The  disease 
has  a  tendency  to  recur  again  and  again,  after  variable  intervals. 

Symptoms.  The  acute  attack  may  be  preceded  by  warnings, — heart- 
burn, flatulence,  dull  pain  in  left  side  of  chest,  irregularity  of  heart's 
action,  dry  skin,  urticaria,  and  urine  loaded  with  urates.  It  may  come 
on  suddenly  in  the  night,  with, — acute  pain  in  great  toe,  heel,  or  instep; 
a  rigor  followed  by  heat ;  tenderness  and  swelling  of  affected  part ;  fever, 
irritability,  and  restlessness;  constipation  with  furred  tongue;  and  urine 
loaded  with  urates,  phosphates,  or  containing  albumen.  The  attack 
passes  off:  an  interval  elapses,  of  length  proportionate  to  the  care 
taken;  and  then  another  attack  follows.  Toplii  or  chalk-stones  form 
round  the  joints,  consisting  chiefly  of  urate  of  soda;  small  deposits  on 
auricle  of  ear. 

Complications :  In  reti-ocedent  gout  metastasis  occurs  from  the  joint 
to  some  internal  organ, — to  the  stomach,  heart,  membranes  of  the  brain. 
Often  caused  by  application  of  cold  to  gouty  limb. 

Gouty  diathesis  without  local  manifestations,  causing  neuralgia,  dys- 
pepsia, palpitation,  syncope,  congestion  of  liver,  urticaria,  piles,  pains 
about  the  head,  toothache,  tonsillitis,  &c. 

Treatment.  Acute  Stage:  Bleeding  to  four  or  six  ounces,  where  the 
constitution  is  sound,  to  relieve  overloaded  heart  and  congested  vessels. 
Mild  laxatives  containing  aloes,  senna,  rhubarb,  jalap,  &c.,  144,  145,  146, 
148,  149,  151.  Calomel,  colchicum,  aloes,  and  ipecacuanha  pill,  46.  Ace- 
tate, citrate,  or  bicarbonate  of  potash.  Emetics.  Opium.  Hot-air  or 
vapor  bath.  Colchicum, — in  Vichy  water,  or  with  sedatives  and  alka- 
lies, or  iodide  of  potassium,  31,  46,  212,  351,  352.  Hellebore  and  colchi- 
cum, 163.  Carbonate  of  ammonia.  Liquor  potassae.  Liquor  sodse.  Sul- 
phur.— Locally  :  Cotton-wool  and  oiled  silk.  Anodyne  lotions,  265,  281, 
297.  One  or  two  leeches.  Poultices,  with  extract  of  belladonna  or 
opiuni.  Ointment  of  veratria.  Small  blisters,  in  chronic  cases. — Diet: 
Milk.  Arrowroot.  Tapioca.  Tea.  Diluents.  Soda  water.  Vichy 
water.     Avoid  animal  food  too  soon. 

Chronic  stage :  Maintain  proper  action  of  bowels  and  skin.  Colchicum. 
Alkalies.  Iodide  of  potassium,  truaiacum.  Extract  of  the  physalis 
alkekengi.  Quassia.  Calumba.  Bark.  Mild  ferruginous  tonics,  394, 
402,  403.  Arsenic,  with  colchicum  or  iodide  of  potassium  or  steel,  52, 
399.  Phosphate  of  soda.  Avoid  opening  chalk-stones  Friction  with 
liniments  of  iodide  of  potassium  or  iodide  of  ammonium,  280.  Regulate 
diet :  Animal  food  in  small  quantity  ;  white  fish  ;  milk  and  eggs.  Avoid- 
ance of  malt  liquors,  port,  and  sherry;  sugar  to  be  used  sparingly. 

In  irregular  or  misplaced  attacks:  Salines  and  colchicum.  Ether.  Am- 
monia. Chloroform.  Brandy.  Mustard  pediluvia.  Warmth  to  the 
joints.     Sinapisms.     Turpentine  stupes. 

To  prevent  repetition  of  attack :  Well-regulated  diet.  Food  from  which 
healthy  chyle  can  be  extracted.  Claret.  Hock.  Hungarian  wines 
(Other  or  Carlowitz).  Brandy  and  water.  Soda  water.  Vichy  water. 
Infusion  of  leaves  of  common  ash.  Mild  aperients.  Carbonate  or  cit- 
rate of  lithia,  64.  Moderate  mental  and  bodily  exertion.  Avoidance  of 
too  great  sexual  indulgence.  Hot-air  or  water  baths.  A  visit  to  Bath, 
46);  Buxton,  464;  Cheltenham,  461 ;  Harrogate.  46i) ;  or  Leamington, 
463.    Wiesbaden,  489.    Vichy,  479.    Carlsbad,  496!    Aix-la-Chapelle;483. 

GRAVEDO. — From  Gravis^  heavy.  Catarrhal  inflammation  of  mem- 
brane lining  frontal  sinuses. — See  Catarrh. 


128  graves'  disease — h^matozoa. 

GRAVES'  DISEASE. — This  name  has  been  given  to  a  singulai-  com- 
bination of  three  symptoms, — palpitation,  protrusion  of  eyeballs,  and 
enlargement  of  thyroid  gland.  More  common  in  females  than  males: 
there  is  often  some  obscure  connection  between  it  and  disturbance  of 
the  uterine  functions.  Generally  believed  that  a  neurosis  of  the  cervi- 
cal sympathetic  nerve  is  the  cause  of  the  affection.  The  cases  run  a 
chronic  course.  The  remedies  to  be  resorted  to  will  depend  on  the  con- 
dition of  the  system ; — i.  e.,  whether  there  is  any  syphilitic  taint,  or 
tuberculosis,  or  simply  a  state  of  an»mia. 

H.ffiIIIATEMESIS. — From  Al/ia,  blood  ;  iiJ-ico,  to  vomit.  Synon.  Gas- 
trorr/uKjiit ;  ILvmorrhcea  Ventrlculi ;  Vomiting  of  Blood. — Hemorrhage 
from  the  stomach  may  be  either  acute  or  chronic;  latter  most  danger- 
ous, as  indicative  of  some  disease  of  abdominal  viscera. 

Symptoms.  Blood  vomited  in  considerable  quantities.  Blood  not 
frothy:  of  a  dark  color.  Blood  mixed  with  food.  Melsena  very  com- 
mon. Gastric  or  duodenal  symptoms.  Perhaps,  simple  or  malignant 
ulcer;  cirrhosis  of  liver;  aneurism  of  one  of  the  branches  of  abdominal 
aorta;  vicarious  menstruation  ;  scurvy. 

Treatment.  In  acute  form  :  Abstinence  from  food.  Perfect  rest  in 
horizontal  posture.  Cold  to  the  epigastrium,  118.  Ice  or  cold  acidulous 
drinks.  Gallic  acid,  103.  Turpentine,  102.  Sulphuric  acid  and  opium, 
100.  Tincture  of  perchloride  of  iron,  101.  Lead  and  acetic  acid,  117. 
Alum  and  sulphuric  acid,  116.  Ipecacuanha.  Enemata  of  beef  tea  and 
brandy,  21,  23. 

In  chronic  form  :  Mineral  acids  with  bark,  376.  Quinine  and  iron,  380. 
Ammonio-sulphate  of  iron,  116.  Cream;  raw  eggs;  essence  of  beef. 
Cod-liver  oil. — See  Mctmoptysis. 

H^MATOID  CANCER. — From  Alaa,  blood;  terminal  -ides.  Synon. 
Fungus  Hecmatudes. — This  disease  is  probably  a  soft  medullary  or  other 
cancer,  the  substance  of  wiiich  has  become  more  or  less  infiltrated  with 
blood.  When  it  protrudes  through  the  skin  it  forms  a  large  vascular 
mass,  somewhat  resembling  a  clot  of  blood. — See  Cancer. 

H.ffiMATOMA  AURIS. — From  J f/iar^w,  to  convert  into  blood;  Auris, 
the  ear. — A  sanguineous  tumor  about  outer  surface  of  auricle  of  ear. 
Often  symmetrical.  Especially  affects  insane.  The  explanation  of  its 
occurrence  is:  (1)  The  states  of  the  circulation,  nutrition,  and  develop- 
ment of  tissues  which  make  up  the  ear-lobule,  and  cover  the  helix,  very 
commonly  coincide  with  similar  conditions  of  the  encephalic  tissues. 
(2)  Development  of  cartilages  of  external  ear,  and  their  several  parts, 
is  in  relation  with  encephalic  and  cranial  development  of  individual 
(Lay cock). — See  Insanity. 

H.ffiMATOZOA. — From  Al/m,  blood  ;  ^ojov,  an  animal. — The  following 
entozoa  have  been  found  in  human  blood  : 

(1)  Distoma  ILematobium. — An  entozoon  with  a  flat  elongated  body 
and  a  cylindrical  tail :  inhabits  the  vena  portse,  and  the  veins  of  the 
mesentery,  liver,  bladder,  and  intestines.  It  is  very  common  in  Egypt, 
and  especially  infests  the  bodies  of  those  who  drink  the  unfiltered  waters 
of  the  Nile,  &c.  It  is  probably  the  cause  of  a  peculiar  form  of  ha^ma- 
turia  somewhat  prevalent  in  Southern  Africa  and  in  the  Mauritius. — 
Chief  remedies:  Calomel.  Turpentine.  The  efticacy  of  either  very 
doubtful. 

(2)  Hexathyridium  Venarum. — About  three  lines  in  length.  Has 
been  found  in  venous  blood,  and  in  sputa  of  patients  with  haemoptysis. 


HiEMATURIA — HEMOPTYSIS.  129 

(3)  Fasciola  Hepatica. — Has  been  discovered  in  the  vena  portffi. 
This  fluke  and  the  Distoma  lanceolatum  are  often  found  in  the  gall-duets 
and  bladder  of  the  sheep,  producing  the  distemper  or  Eot. — See  Eiitozoa. 

HJEMATURIA. — From  Aliia,  blood;  o5/5ov, urine.  Synon.  Hcvmuresis ; 
Sanguis  in  Urina ;  Bloody  Urine. — Hemorrhage  from  the  mucous  mem- 
brane of  the  urinary  passages, — the  kidnej^s,  bladder,  or  urethra. 

Symptoms.  Urine  smoky,  or  of  a  black  hue,  or  of  a  port-wine  tint. 
Albumen  present.  When  from  kidney,  the  blood  equally  diffused 
through  the  urine.  When  from  bladder  or  urethra,  blood  comes  away 
after  passing  clear  urine.  Blood-casts  of  renal  tubes?  Cancer  cells.? 
Eenal  calculi  ? 

Endemic  haematuria  of  Egypt,  Southern  Africa,  and  Mauritius  due  to 
the  Distoma  hajmatobium. — See  Hcematozoa. 

Treatment.  In  malignant  disease  or  calculus:  Gallic  acid,  103.  Tinc- 
ture of  perchloride  of  iron,  101.  Sulphuric  acid  and  opium,  100.  Infu- 
sion of  matico.  Euspini's  styptic.  Turpentine.  Creasote.  Krameria. 
Ergot  of  rj^e.  Opium.  Rest  in  recumbent  posture.  Sinapisms.  Turpen- 
tine stupes.     Application  of  ice  to  loins. 

In  renal  disease,  or  some  morbid  poison  in  the  blood :  Hot  air  baths. 
Warm  water  baths.  Compound  jalap  powder.  Ferruginous  tonics, — 
especially  tincture  of  perchloride  of  iron,  a'nd  iron  alum. 

From  disease  of  urethra:  Aj>plication  of  ice.  Use  of  a  large  bougie 
for  some  hours. 

Vesical  hemorrhage :  Injections  of  alum  or  tannin,  grs.  30  to  water  fl. 
oz.  X.     Ice  to  pubes.     Ammonio-sulphate  of  iron,  116. 

H^MOGASTRIC  FEVER.— From  Alfia,  blood;  y^ffrrip,  the  stomach. 
Synon.  Febris  Flara ;  Festilentia  Hcemagastrica;  Festis  Infertropica ;  Ty- 
phus Icterodes;  Synochus  Icterodes;  Malignant  Pestilential  Fever. — See 
Yellow  Fever. 

HEMOPTYSIS.— From  A^im,  blood;  xruw,  to  spit.  Synon.  Emoptoe ; 
Sputum  Sanguinis;  Hiemorrhagia  Pulmonis;  Pneumorrhagia. — The  escape 
of  blood  through  the  mouth — from  larynx,  trachea,  bronchial  tubes,  or 
air-cells  of  lungs.  Of  little  consequence,  comparatively,  when  due  to 
some  accidental  and  transitory  cause.  An  important  indication  of  bron- 
chial, pulmonary,  cardiac,  or  aortic  disease  when  of  frequent  recurrence, 
at  variable  intervals. 

Symptoms.  Blood  coughed  up  in  mouthfuls.  Blood  frothy,  and  of  a 
florid  red  color.  Blood  mingled  with  sputa.  Absence  of  mela?na.  Bron- 
chial or  pulmonary  symptoms.    Tubercular  deposit?    Aortic  aneurism? 

Distinction  between  haBmoptysis  and  hffimatemesis: 

In  hcemoptysis :  In  hannatemesis : 

Dyspnoea  ;  pain  or  heat  in  chest.  Nausea  ;  epigastric  tension. 

Blood  coughed  up  in  mouthfuls.  Blood  vomited  profusely. 

Blood  frothy.  Blood  not  frothy. 

Blood  of  a  florid  red  color.  Blood  dark  colored. 

Blood  mingled  with  sputa.  Blood  mixed  with  food. 

Absence  of  melsena.  Melsena  very  common. 

Bronchial  or  pulmonary  symptoms.  Gastric  or  duodenal  symptoms. 

Treatment.  Strict  mental  and  bodily  repose.  Rest  in  bed.  Head 
and  shoulders  to  be  elevated.  Unstimulating  diet.  Ice  and  cold  drinks. 
Blisters.     Turpentine  stupes.     Sinapisms.     Dry  cupping.     Ice  to  chest. 

(jrallic  acid,  1U3.  Mineral  acids,  99.  lUO,  115.  Acetic  acid.  Ammonio- 
sulphate  of  iron,  116.    Acetate  of  lead  and  opium,  117.    Creasote.    Com- 

9 


130  HEMORRHAGE — HEMORRHOIDS. 

men  salt?  Ergot  of  lye.  Turpentine,  102.  Alnm.  Infusion  of  matieo. 
Hydrocyanic  acid.  Morphia.  Emetics  of  ipecacuan.  Antimonj- ?  Digi- 
talis? Leeches?  Venesection?  A  ligature  round  the  limbs.  Inhalation 
of  atomized  fluids,  medicated  with  tannic  acid,  alum,  perchloride  of 
iron,  or  turpentine,  262. 

H.ffiMORRHAGE. — Synon.  Sanguifliixus ;  ITcemorrhoea ;  Loss  of  Blood; 
Rupture  of  a  Bloodvessel. — The  escape  of  blood  from  the  vessels  in  which 
it  is  naturally  contained  constitutes  haemorrhage  {Jicemorrhagia,  from 
A\iJ.a,  blood ;  prjvuiu.  to  break  out). 

Varieties.  The  chief  subdivisions  are  these:  (1)  Traumatic  when  a 
vessel  has  been  directl}^  divided,  and  spontaueovs  when  the  bleeding  has 
resulted  fi-om  some  constitutional  cause.  (2)  Symptomatic  when  clearly 
a  result  of  some  disease,  as  tubercle,  cancer,  &c.,  and  idiopathic  or  essen- 
tial, when  no  such  connection  has  been  perceptible.  Or,  (3)  active  hemor- 
rhage when  congestion  or  inflammation  has  preceded  the  flow,  and 
passive  when  there  have  previously  existed  signs  of  debility,  with  pov- 
erty of  blood.  Moreover,  hemorrhages  have  been  termed  constitutional 
when  they  occur  at  intervals,  and  seem  to  be  of  service  to  general 
health,  as  in  the  bleeding  from  piles  in  plethoric  people:  vicarious  when 
su])plenu'ntal  of  some  other  hemorrhage,  as  where  a  woman  has  peri- 
odical bleeding  from  nose  in  place  of  usual  catamenial  discharge:  and 
sometimes  spoken  of  as  critical  when  they  occur  during  progress  of 
some  disease,  and  produce  marked  good  or  bad  effects. 

The.  seat  of  the  hemorrhage  is  likely  to  vary  with  the  patient's  age. 
Bleeding  from  the  nose  is  most  common  in  youth :  from  the  lungs  and 
bronclii,  stomach,  urinary  passages,  and  uterus  in  adults:  and  from  the 
cerebral  vessels  and  rectum  in  old  age. 

Treatment.  Cool  apartment.  Eepose.  Freedom  from  excitement. 
Simple  and  unstimuhiting  diet.  Position  such  as  to  prevent  afliux  of 
blood  to  bleeding  organ.  Application  of  cold.  Turpentine  stupes.  Blis- 
ters.    Ligatures. 

Ice.  Gallic  acid.  Tannin.  Mineral  acids.  Ammonio-sulphate  of 
iron.  Tincture  of  perchloride  of  iron.  Creasote.  Ipecacuanha.  Ace- 
tate of  lead.  Ruspini's  styptic.  Oil  of  turpentine.  Nitrate  of  silver. 
Oxide  of  silver.  Alum.  Kino.  Matieo.  Ehatany.  Corrosive  sub- 
limate. Calomel.  Ergot  of  rye.  Opium.  Venesection.  Digitalis. 
Aperients.  Transfusion. — ^qq  Apoplexy ;  Epistaxis;  Hcematemesis ;  Hcem- 
aturia. ;  Hcemoptysis ;  Menorrhagia;  Melcena;  Otorrhagia;  Stomatorrha- 
gia. 

HEMORRHAGIC  DIATHESIS.— May  be  hereditary,  or  will  perhaps 

be  induced  by  insutiicient  food. 

Symptoms.  Ecchj'moses.  Dropsy.  Painful  swellings  round  joints. 
Bleeding  from  umbilicus  a  few  days  after  birth;  from  nose  or  gums  in 
youth  ;  from  urinary  passages  or  rectum  in  after-life.  Fatal  loss  of  blood 
after  leech-bite,  extraction  of  a  tooth,  rupture  of  hymen.  &c. 

Treatment.  Avoidance  of  surgical  operations.  Caution  after  acci- 
dents.    Nourishing  food. — See  Haemorrhage. 

H-ffiMORRHOIDS.— From  Al/ia,  blood ;  pico.  to  flow.  Synon.  Proctal- 
gia Ha'Tiiorrhoidalis;  Piles. — Small  tumors  situated  within  or  at  verge 
of  anus.  Two  varieties  :  (1)  ixferna/,  or  those  outside  sphincter  muscle. 
(2)  Internal,  or  such  as  are  within  sphincter.  Often,  the  two  kinds 
coexist. 

1.  External  Haemorrhoids. — Consist  either  of  a  knot  of  varicose  veins, 


HEADACHE.  131 

or  of  one  or  more  cutaneous  excrescences.  In  first  case,  the  veins  may- 
contain  fluid  blood:  more  frequentl}^  their  contents  have  coagulated, 
forming  one  or  several  tense  and  purple  swellings.  The  excrescences 
consist  chiefly  of  hypertrophied  skin  and  areolar  tissue. 

Symptoms.  When  indolent,  only  troubleson)e  from  their  bulk.  If 
they  become  congested  or  inflamed,  considerable  pain  arises;  with  heat 
and  throbbing,  tenesmus,  backache,  irritability  of  bladder,  perhaps  re- 
tention of  urine,  and  uterine  irritation  in  women. 

Treatment.  Daily  action  of  bowels  to  be  procured.  Confection  ot 
pepper.  Confection  of  senna.  Confection  of  sulphur.  Compound  elec- 
tuaries, 194.  Simple  enemata,  188.  Sulphur  and  magnesia,  153.  Pep- 
sine  and  extract  of  aloes,  155.  (Jastor  oil.  Mercury  and  chalk.  Taraxa- 
cum. Pullna  water.  Anus  to  be  sponged  with  cold  water  after  every 
stool.  Sponging  parts  round  anus,  when  relaxed,  with  lotions  of  alum 
or  tannic  acid.  Ointment  of  galls.  Ointment  of  galls  and  opium. — 
Plain  nourishing  food;  free  from  highly  seasoned  dishes,  coffee,  and 
alcoholic  stimulants. — Hot  bathing  and  poultices,  where  there  is  inflam- 
mation.— Incision,  with  evacuation  of  contained  clot,  when  tumor  is 
swollen  and  tender. — Excision  of  growths  with  curved  scissors. 

2.  Internal  Haemorrhoids. — May  be  simple  or  multiple.  Of  three  kinds : 
(1)  S]>ongy  vascular  growths,  having  a  red  granular  appearance,  and 
soft  elastic  texture  like  that  of  erectile  tissue.  (2)  Made  up  of  lower 
branches  of  the  plexus  of  hgemorrhoidal  veins.  Branches  dilated  :  often 
plugged  with  coagula.  (3)  Pendulous  tumors,  composed  of  fibro-areolar 
tissue. 

Symptoms.  The  piles  only  protrude  during  defecation  at  first.  After- 
wards, as  sphincter  gets  dilated  by  their  jjressure,  and  relaxed  by 
attacks  of  hemorrhage,  they  are  constantly  down  save  when  patient 
is  in  recumbent  posture.  Loss  of  blood,  from  a  mere  tinging  of  fffices 
to  escape  of  many  ounces.  Uneasiness  about  rectum  :  tenesmus.  Irri- 
tability of  bladder,  and  of  uterus  in  women.  Muco-purulent  discharge. 
Loss  of  flesh.  Anjemia.  Sallowness  of  complexion.  Derangement  of 
functions  of  liver,  stomach,  and  bowels,  &c. 

Treatment.  Daily  action  of  bowels  to  be  insured  by  remedies  re- 
commended for  external  piles.  Improvement  of  general  health.  Atten- 
tion to  functions  of  liver,  digestive  organs,  &e.  Nitro-hydrochloric  acid. 
(Quinine.  Arsenic.  Sulphur.  Cold  water  enemata.  Enemata  of  solu- 
tions of  gallic  acid,  alum,  ammonio-iron  alum,  or  of  tincture  of  per- 
chloride  of  iron  to  check  hemorrhage.  When  protruded  piles  cannot 
be  replaced,  it  may  be  necessary  to  reduce  their  size  by  applying  ice, 
or  by  puncturing,  before  making  further  attempts.  If,  from  constric- 
tion of  sphincter,  protruded  piles  have  become  strangulated  and  more 
or  less  gangrenous,  they  must  be  poulticed,  and  pain  relieved  by  opiates, 
till  they  slough  oft'. 

Radical  cures:  By  cauterization  with  nitric  acid.  Simple  excision 
dangerous,  owing  to  probability  of  hemorrhage.  Excision  with  ecraseur. 
Use  of  clamp  and  excision  ;  appljang  actual  cautery,  or  nitric  acid, 
before  removing  clamp.  Operation  by  ligature  the  safest  and  most  to 
be  recommended. 

HEADACHE. — Synon.  Cephalalgia,  iroxn  KsipaXri,  the  head;  a'A^o?,  pain. 
— Of  common  occurrence  during  progi'css  of  most  acute  and  many 
chronic  diseases.  Affects  adults  more  than  young  or  old ;  inhabitants 
of  towns  more  than  country  folk:  nervous  and  delicate  more  than 
robust :  higher  classes  of  society  more  than  lower. 

Varieties.     Pour  principal  forms  may  be  noticed :  (1)  Organic  head- 


132  HEMERALOPIA — HEMICRANIA. 

ache,  due  to  disease  of  bvain  or  membranoe,  and  especially  of  such  in 
early  stage.  Accompanied  by  vertigo;  sometimes  by  vomiting,  confu- 
sion of  mind,  noises  in  ears.  Pain,  sliarp  or  dull  or  lancinating  or  throb- 
bing :  more  severe  in  disease  of  meninges  than  of  brain  substance.  When 
due  to  inflammation,  pain  intense,  increased  by  warmth  or  noise  or 
movements,  and  lessened  b}'"  elevating  head. — In  valvular  disease  of 
heart,  the  interrupted  supply  of  blood  to  nervous  system  causes  head- 
ache. 

(2)  Plethoric  headache,  dependent  on  congestion  of  cerebral  vessels. 
Sense  of  pulsation  in  ears  :  giddiness  on  stooping.  Constipation.  Those 
who  live  too  freely,  take  but  little  exercise,  rise  late  in  morning,  &c., 
are  subject  to  it.  It  may  arise  from  sudden  suppression  of  accustomed 
discharge,  as  of  catamenia. 

(3)  Bilious  headache,  temporary  or  constant.  When  temporary,  pro- 
duced by  some  error  of  diet,  any  excess  in  food  or  wine.  Most  severe 
in  morning,  after  restless  night.  Passes  away  with  cause.  Constant 
sick  headache  occurs  in  persons  with  w^eak  stomachs,  and  in  the  gouty. 
Stomach  and  duodenum  out  of  order:  tongue  coated,  breath  offensive, 
flatulence,  low  s]»irits,  nausea.  Hepatic  functions  ill-performed;  stools 
clay-colored.     Urine  scanty  and  high-colored. 

(4)  Nervovs  headache,  often  owing  to  debilit}'  and  exhaustion.  Poverty 
of  blood  from  renal  disease,  hemorrhage,  &c.,  may  induce  it.  Irritation 
of  decayed  teeth,  or  off'ensive  stumps,  a  frequent  cause. — In  hemicrania, 
or  brow-agne,  symptoms  are  intermittent,  recurring  with  regularity  of 
an  ague  fit. — The  megrims  is  a  form  which  aff'ects  delicate  women,  espe- 
cially if  exhausted  by  over-lactation. — When  hysterical  young  women 
suffer  from  nervous  headache  it  is  often  confined  to  a  single  spot,  resem- 
bles the  pain  of  driving  a  nail  into  the  part,  and  is  known  as  clavus  hys- 
tericus. 

Treatment.  The  indications  are  to  relieve  congestion  of  head  and 
dyspeptic  symptoms,  while  tone  is  given  to  general  system.  Diet  to  be 
regulated:  often  beneficial  to  discontinue  tea  and  coff'ee.  Milk  taken  at 
night  may  be  injurious.  Tobacco  in  all  forms  to  be  forbidden.  In 
organic  headaches,  attention  to  be  paid  chiefly  to  cerebral  mischief. 

Sulphate  of  soda  and  taraxacum,  144.  Aloes,  gentian,  and  liquor 
potassa>,  148.  Pej)sine  and  aloes,  155.  Ehubarb  and  magnesia,  165. 
Rhubarb  and  blue  ])ill,  171.  Nux  vomica  and  rhubarb,  175.  Colchicum, 
46.  Phosphate  of  iron,  4U5.  Effervescing  citrate  of  magnesia.  Hydro- 
chlorate  of  ammonia,  60.  Aconite.  Camphor.  Nitro-hydrochloric  acid, 
378.  Where  there  is  albuminuria,  iron  alum,  116:  tincture  of  per- 
chloride  of  iron  and  hydrochloric  acid,  101.  Quinine  or  arsenic  in  hemi- 
crania, 52,  379,  381.  Zinc  or  steel  in  hysterical  forms,  394,  403, 410,  414. 
Stramonium.  Shower  baths.  Mustard  pediluvia.  Holding  arms  high 
above  the  head  sometimes  palliative,  owing  to  effect  on  cerebral  circu- 
lation. Compression  of  temporal  arteries  with  pads  and  a  bandage 
round  forehead.  Cold  lotions,  sponge  dipped  in  cold  water,  eau  de 
Cologne,  ifcc,  to  forehead  and  crown.  Dry  cupping,  or  blisters,  or  sina- 
pisms, or  setons,  to  nape  of  neck.  Extraction  of  bad  teeth.  Change  of 
air. 

HEMERALOPIA. — From  "Hfiipa,  daylight;  oTZToimi,  to  see.  Synon. 
Visus  Diurnus ;  Dysojria  Tenebrarum ;  Day-vision. — That  condition  in 
which  vision  is  only  distinct  during  daylight — See  Amaurosis. 

HEMICRANIA.— From  "H/icffo^,  half;  xpau{ov,  the  skull.  Synon.  Hem- 
icephahva ;  Neuralgia  Cerebral  is  ;  Megrims. — Headache  affecting  one  side 
of  brow  and  forehead. — See  Neuralgia ;  Headache. 


HEMIOPIA — HEPATIC   ATROPHY.  133 

HEMIOPIA. — From  "Hfj.c(Tu<;,  half;  cu</',  the  eye.  Synou.  Visus  Dimid- 
iatus;  Amaurosis  Dimidiata. — That  form  of  faulty  vision  in  which  only 
half  an  object  is  seen. — See  Amaurosis. 

HEMIPLEGIA. — From  "Hiuau^,  half;  TzXrjrrffu),  to  strike.  Synon.  Sem- 
ipJcgia ;  Semisideratio. — Paralysis  limited  to  one  side  of  the  body.  See 
Paralysis. 

HEPATIC  ATROPHY.— From  'Hxarixdq,  affecting  the  liver:  'J,  priv.; 
Tpi<poj,  to  strengthen  or  support.  The  secretion  of  bile  may  be  sus- 
pended owing  to  acute  atrophy;  as  well  as  from  cirrhosis,  extensive 
cancer,  &c. — See  Acholia. 

1.  Acute  Atrophy  of  Liver. — Synon.  Yelloto  Atrophy  of  Liver;  Acute 
Wasting  of  Liver;  Softening  of  Liver;  Lif used  Hepatitis ;  Fatal  Jaun- 
dice.— A  most  remarkable  disease  ;  consisting  as  a  rule,  of  a  rapid  and 
complete  destruction  of  hepatic  cells  through  every  part  of  the  gland. 
Women  more  obnoxious  to  this  rare  affection  than  men;  pregnancy 
seems  to  predispose  to  it.  Among  other  alleged  exciting  caugesai'e, — 
grief  or  anxiety,  sudden  alarm,  fits  of  passion;  venereal  excesses,  syph- 
ilis, excessive  use  of  mercury;  drunkenness  and  dissolute  habits; 
poisons  of  malaria  and  typhus.  Many  points  of  resemblance  between 
acute  atrophy  and  yellow  fever. 

Symptoms.  Preliminary  stage :  Headache,  loss  of  appetite,  thirst, 
drowsiness,  mental  and  bodily  depression,  irregularity  of  bowels,  ten- 
derness of  abdomen.  Then  conjunctivae  become  yellow :  skin  gets 
slightly  jaundiced.  These  precursory  symptoms  may  last  from  a  few 
days  to  three  or  four  weeks;  or  may  be  altogether  absent. 

Confirmed  stage :  Jaundice;  perhaps  with  petechia  and  large  ecehy- 
moses.  Yomiting;  at  first  of  mucus,  afterwards  of  matter  like  coffee- 
grounds  (altered  blood).  Irritability,  great  despondenc}^ ;  soon  followed 
by  wandering  merging  into  noisy  delirium  and  convulsions,  stupor  and 
deep  coma. — Tongue  and  teeth  coated  with  black  sordes.  Pains  about 
epigastric  and  right  hypochondriac  regions.  Diminution  of  hepatic 
dulness:  increased  area  of  splenic  dulness.  Obstinate  constipation: 
purgatives  bring  away  hard  clay-colored  stools;  at  later  period,  evacu- 
ations black  from  presence  of  blood.  Difficult  micturition ;  urine 
loaded  with  bile  pigment,  perhaps  albuminous,  and  containing  tyrosine 
and  leucine. — Increase  of  jaundice.  Bedsores,  if  life  be  prolonged 
beyond  eight  or  nine  days.  Hemorrhages  from  nose,  stomach,  bowels, 
bronchi,  <fec. 

Death  usually  occurs  within  a  week  from  commencement  of  confirmed 
stage:  sometimes  within  eighteen  or  twenty-four  hours. 

Treatment.  Empirical  and  probably-  useless.  Usual  remedies : 
Drastic  purgatives;  then  mineral  acids,  with  dift'iisible  stimulants  as 
prostration  increases.  Large  doses  of  quinine  and  mineral  acids.  Ice. 
Cold  drinks. 

2.  Chronic  Atrophy  of  Liver. — This  disease  is  in  no  way  connected 
with  acute  atropli}^  It  results  from  all  those  conditions  which  tend  to 
arrest  the  capillary  circulation  through  the  gland,  and  hence  to  lessen 
its  nutrition. 

Symptoms.  Developed  slowl}^  and  insidiously.  Imperfect  digestion: 
flatulence,  diarrhoea  alternating  with  constipation,  pale-colored  stools. 
Dry  sallow  skin.  Loss  of  flesh  and  strength.  Ana?mia  :  persistent 
wasting:  perhaps  dropsy  :  finally,  there  may  be  fatal  exhaustion. 

Treatment.  Light  nourishing  food  :  avoidance  of  rich  dishes,  sugar, 
fermented  drinks,  coffee.     Warm  clothing;.     Over-fatigue  to  be  guarded 


134  HEPATIC    CALCULI — HEPATIC    CONGESTION. 

against. — Pepsine,  420.  Purified  ox  bile  with  ammonia,  170.  Quinine 
and  ipecacuanha,  44,  384.  Quinine  and  rhubarb,  385.  Bark  and  min- 
eral acids,  376.  Harrogate  waters,  466.  Spa,  467.  Kissingen,  493. 
Marienbad,  497. — If  dropsy  sets  in:  Squills,  digitalis,  and  broom,  219. 
Bnchii  and  acid  tartrate  of  potash,  222.  Nitre,  juniper,  and  ether,  221. 
Tapping,  to  afford  temporary  relief. 

HEPATIC  CALCULI. — From  'Hrarud^,  affecting  the  liver;  Calculus 
(dimin.  of  calx),  a  small  stone, — See  Gall-stones. 

HEPATIC  CANCER. — From  "HTzaTcxdc;,  affecting  the  liver. — Every 
variety  of  cancer  has  been  met  with  in  the  liver.  Medullary  more 
common  than  scirrhus. 

Symptoms.  In  addition  to  general  inrlications  of  malignant  disease: 
Enlargement  of  gland  :  loss  of  regular  form  :  detection  of  uneven  bulg- 
ing prominences.  Nodulous  masses  often  give  rise  to  partial  peritonitis. 
Daily  increasing  loss  of  flesh  and  strength.  Diffused  abdominal  pain 
and  tenderness.  Indigestion.  Irritability  and  mental  depression. 
Jaundice  occurs  more  frequently  than  ascites:  occasionally  both 
present.  Formation  of  gall-stones  not  uncommonly  adds  materially  to 
the  suffering. 

Duration,  except  in  scirrhus,  short.  Life  seldom  prolonged  for  two 
years,  sometimes  only  for  six  months,  from  onset  of  symptoms. 

Treatment.  Opium.  Belladonna.  Conium.  Ammonia  and  bark. 
Mineral  or  vegetable  acids.     Light  nourishing  diet.— See  Cancer. 

HEPATIC  CONGESTION. — From'//^ar«oc,  affecting  the  liver.  Synon. 
Hypera'.mia  of  the  Liver ;  Congestion  of  the  Liver. — Two  varieties  to  be 
described : 

1.  Passive,  Congestion. — Simplest  form.  Results  from  some  obstruction 
to  circulation  through  hepatic  and  portal  veins.  Occurs  in  valvular  affec- 
tions of  heart;  in  morbid  states  of  lungs  impeding  passage  of  blood 
through  pulmonary  artery;  in  diseases  which  diminish  capacity  of 
thoracic  cavity ;  temporarily,  from  violent  exercise,  &c.  Leads  to 
diminished  excretion  of  bile  :  ducts  become  gorged  with  bile — biliary 
congestion. 

Symptoms.  Sense  of  constriction  and  weight  in  rigbt  hypochondrium. 
Often,  slight  jaundice,  nausea,  dyspepsia  :  urine  scanty,  high-colored, 
perhaps  contains  bile-pigment,  with  traces  of  albumen  :  constipation 
and  haemorrhoids.  Area  of  hepatic  dulness  found  to  be  increased  on 
percussion.     Symptoms  of  cardiac  or  pulmonary  disease,  &c. 

Treatment.  Sulphate  and  carbonate  of  magnesia,  141.  Sulphate  of 
soda  and  sulphuric  acid,  143.  Aloes,  senna,  and  sulphate  of  magnesia, 
150.  Antimony  and  magnesia,  152.  Nitric  acid,  senna,  and  taraxacum, 
147.  Ammonia  and  rhubarb,  161.  Sulphates  of  magnesia  and  iron, 
166.  Leeches  to  anus.  Harrogate  waters,  466.  Carlsbad,  496.  Kis- 
singen,  493.     Marienbad,  497.     Simple  diet.     Avoidance  of  stimulants. 

2.  Active  Congestion. — Capillaries  of  hepatic  artery  chiefly  affected. 
Produced  by  morbid  matters  in  blood ;  suppression  of  habitual  dis- 
charges, i.  e.  hfemorrhoidal,  catamenial,  &c. ;  long  residence  in  hot  cli- 
mates; deranged  nervous  influence;  atony  of  bloodvessels  from  disease 
of  coats;  excessive  eating  and  drinking,  alcohol,  &c. ;  sedentary  habits. 

Symptoms.  Fulness  and  sense  of  tightness  about  right  hypochondrium. 
Slight  enlargement  of  gland.  Pains  about  right  shouldei-.  Headache; 
loss  of  appetite;  mental  depression;  nausea;  irregularity  of  bowels, 
bilious  stools,  &c.     These  symptoms  soon  pass  off,  unless  the  congestion 


HEPATIC    DEGENERATIONS.  135 

be  kept  up  by  non-removal  of  the  cause;  in  which  ease  structural  dis- 
ease may  ultimately  result,  with  jaundice,  perhaps  suppurative  fever, 
perhaps  di'opsy,  &c. 

Treatment.  Removal  of  cause.  Horse  exercise,  walking,  &c.  Simple 
diet:  white  fish,  fresh  vegetables,  rice,  weak  tea,  &c.  Aloes,  gentian, 
and  solution  of  potash,  148.  Sulphate  of  soda  and  taraxacum,  144. 
Aloes,  senna,  and  jalap,  145.  Eesin  of  podophyllum.  Sulphate  of  man- 
ganese, 172.     Nitro-hydrocbloric  acid,  378. 

3.  Apoplexy  of  Liver. — Extravasated  masses  of  blood  sometimes  found 
in  hepatic  tissue,  or  beneath  the  capsule.  Results  of  great  congestion 
induced  by  morbid  changes  in  the  blood.  Occur  in  scurvy,  purpura, 
ichorhffim'ia,  and  especially  in  malarious  fevers  of  tropical  climates. 
Extravasations  often  numerous:  vary  in  size  from  a  pea  to  a  hen's  egg: 
or  blood  may  be  infiltrated  through  parenchyma,  converting  the  tissue 
into  a  pulpy  mass. 

HEPATIC  DEGENERATIONS.— From  'H-arcxd^,  affecting  the  liver: 
Degenero,  to  degenerate. — Three  varieties: 

1.  Fatty  Degeneration  of  Liver.  Synon.  Hepar  Adiposum  ;  Fatty  Liver. 
— A  great  increase  in  the  quantity  of  oil  naturally  contained  in  the 
hepatic  cells;  so  that,  on  minute  examination,  the  latter  are  found 
gorged  with  oil-globules,  diminishing  the  normal  granular  matter,  and 
quite  obscuring  the  nucleolated  nuclei. 

Of  frequent  occurrence  in  phthisis,  and  in  flitty  degeneration  of  other 
important  organs.  May  affect  those  who  live  too  freely,  who  lead 
indolent  lives.  Has  been  observed  in  constitutional  syphilis ;  as  well  as 
after  death  from  ichorhfemia,  typhus,  small-pox,  erysipelas,  &c. 

Symptoms.  If  cells  be  excessively  loaded,  they  may  impede  capillary 
circulation,  and  obstruct  excretion  of  bile.  Gastric  catarrh,  dyspepsia, 
constipation  alternating  with  diarrhcea,  pasty-looking  complexion, 
anffimia,  hemorrhoids,  &c.,  may  be  present.  Possibly,  ascites ;  complete 
acholia;  or  fatal  exhaustion. 

Treatment.  Regulation  of  diet :  plainly  cooked  animal  food,  fresh 
ripe  fruits.  Avoidance  of  alcohol,  sugar,  amylaceous  matters,  and  fat. 
Daily  exercise.  Sulphate  of  soda  and  taraxacum,  144.  Alkaline  ape- 
rients, 148.  Rhubarb  and  magnesia,  165.  Hydrochlorate  of  ammonia, 
60.  Iodide  of  potassium,  31.  Harrogate  waters,  466.  Carlsbad,  496. 
Kissingen,  498.     Selters,  487. 

2.  Amyloid  Degeneration.— From  Amylum,  starch.  Synon.  Waxy, 
Albuminous,  Lardaceous,  or  Scrofulous  Liver.  May  coexist  Avith  fatty 
liver,  cirrhotic  induration,  syphilitic  cicatrices  and  gummatous  nodules, 
or  be  alone  present.  The  glandular  structure  is  gradually  converted 
into  a  dense  material:  hence,  destruction  of  hepatic  cells  with  abolition 
of  their  functions.  After  death,  liver  found  increased  in  weight  and 
size :  may  average  8  or  9  lbs.  avoir,  instead  of  3  or  4  lbs.  Substance 
tough,  resembling  yellow  wax :  cut  surface  presents  only  faint  traces  of 
lobules. 

Chief  predisposing  causes, — Caries  and  necrosis  in  strumous  subjects  ; 
constitutional  syphilis;  tubercular  disease  of  lungs  and  intestines;  and 
perhaps  intermittent  fever. 

Symptoms.  Enlargement  of  liver.  Sense  of  fulness  in  right  hypo- 
chondrium.  Enlargement  of  spleen.  Loss  of  appetite.  Dyspepsia : 
flatulence,  attacks  of  diarrhoea  with  pale  stools,  nausea.  Albuminuria, 
from  coexistence  of  same  disease  in  kidneys.  Very  rarely,  acute  pain; 
jaundice;  ascites.  Disease  slowly  but  steadily  advances  to  fatal  ter- 
mination. 


136  HEPATIC    HYPERTROPHY — HEPATIC    TUMORS. 

Treatment.  TJnsatisfactoiy.  Attempts  to  be  made  to  relieve  the 
cause,  and  prominent  symptoms.  Iodide  of  potassium.  Iodide  of  iron. 
Ferruginous  tonics.  Warm  or  tepid  sea-water  baths.  Digestible  food. 
— See  Amyloid  Degeneration. 

3.  Pigment  Liver. — Synon.  Melancemic  Liver. — After  death  from  severe 
intermittent,  remittent,  or  continued  fevers,  the  liver  is  sometimes  found 
to  present  a  blackish  or  chocolate  color.  This  is  due  to  accumulation 
of  pigment  matter  in  vascular  apparatus  of  the  gland  (Frerichs).  The 
loading  of  the  hepatic  capillar'ies  with  this  melanotic  matter,  leads  to 
their  destruction,  and  consequent  atrophy  of  the  gland.  The  resulting 
gastric  catarrh,  diarrhoea,  iand  severe  cerebral  symptoms  or  ascites,  are 
incurable. 

HEPATIC  HYPERTROPHY.— From  'HTza-cxd-,  affecting  the  liver: 
'T-rsft,  in  excess;  rpifiu^  to  nourish. — Hyperti'ophy  of  liver  characterized 
by  an  increase  in  the  secreting  cells,  causing  general  enlargement  of 
the  gland.  Hepatic  cells  may  be  increased  in  size,  or  multiplied  in 
number. 

Arises  from  long-continued  congestion,  such  as  occurs  in  residents  of 
tropical  climates  or  of  malarious  districts.  Sometimes  found  in  leucocy- 
themia,  phthisis,  dysenleiy,  saccharine  diabetes,  &c.  Partial  h^-per- 
trophy  may  be  of  a  compensatory  nature;  i.  e.,  a  portion  of  gland 
having  been  rendered  useless  by  disease,  the  healthy  part  has  its  cells 
enlarged  so  as  to  prevent  systemic  derangement. 

HEPATIC  TUMORS.— From  'Hizarub^,  affecting  the  liver:  Tumor 
(tumeo),  a  tumor. — The  most  significant  new  formations  having  their 
seat  in  the  liver  are  the  hydatid  tumors  and  cancerous  infiltrations  (see 
Hepatic  Cancer).  There  are,  however,  two  or  three  other  growths 
which  may  be  met  with. 

1.  Cystic  Tumors. — Enc3-sted  knotty  tumors,  containing  a  cheese  like 
substance,  are  found  in  the  glandular  substance,  varying  in  size  from 
that  of  a  large  pea  to  a  small  potato.  They  have  their  origin  in  in- 
flammation of  mucous  lining  of  hepatic  ducts.  Steatomatous  contents 
composed  of  irregular  granules,  free  oil  globules,  and  occasionally  plates 
of  cholesterine. 

Simple  serous  cysts,  with  clear  watery  contents,  are  sometimes  scat- 
tered through  the  liver.     Seldom  larger  than  small  beans. 

Sacculated  cysts,  containing  a  glairy  fluid,  may  be  met  with.  Very 
rarely,  the  liver  has  been  crowded  with  such  cavities. 

2.  Cavernous  Tumors. — Common]}^  found  on  the  upper  surface  of  the 
gland,  especially  in  bodies  of  aged  persons.  They  are  developed  in  the 
hj'pertrophied  connective  tissue.  On  the  surface,  the}^  look  like  dark 
blue-colored  spaces,  varying  in  size  from  that  of  a  pea  to  a  fowl's  egg: 
on  cutting  into  them,  a  tissue  is  found  resembling  that  of  the  corpora 
cavernosa  of  penis,  containing  dark  blood. 

3.  Tuberculosis. — Tubercular  deposits  very  rare  in  liver:  probably 
never  occur  primarily,  but  always  in  connection  with  far  advanced 
tuberculosis  of  other  organs — especially  of  abdominal  viscera.  Deposit 
takes  place  over  all  parts  of  the  gland,  in  shape  of  semi-transparent 
miliary  granules,  or  as  yellow  adipose  de2)0sits.  Patient  usually  suc- 
cumbs to  constitutional  affection  before  stage  of  softening  sets  in. 

4.  Hydatid  Tumors. — From  'T3aTi<;,  a  vesicle.  Synon.  Echinococci  of 
the  Liver. — Hydatid  tumors  occur  in  the  liver  more  frequently  than  in 


HEPATITIS.  137 

other  organs.  They  are  occasionally  met  with,  however,  in  subperito- 
neal areolar  tissue,  spleen,  omentum,  muscles  of  heart,  brain,  kidneys, 
lungs,  ovaries,  and  bones — particularly  the  tibia. 

Tliese  growths  consist  of  a  sac  formed  by  condensation  of  surround- 
ing tissue,  lined  by  a  thin  bladder  or  c_yst,  and  filled  with  a  limpid  salt 
fluid;  floating  in  which  are  usually  found  numerous  small  bladders, 
which  contain  the  entozoon  known  as  the  echinococcus  ('E/Jvo:;,  a  hedge- 
hog, and  xoy-xog,  a  beny).  Hence,  the  term  "echinococcus  cysts"  is 
sometimes  used  synonymously  with  "hydatids."  The  echinococci  are 
immature  tapeworms — the  scolices  or  embryos  of  the  Taenia  echinococ- 
cus which  infests  the  dog  and  wolf 

Symptoms.  A  hydatid  tumor  in  the  liver  grows  slowly.  Ma}*  give 
rise  to  little  inconvenience  beyond  a  sensation  of  weight.  When  large 
it  is  easily  detected  :  volume  of  liver  increased.  Occasionally,  fluctua- 
tion :  in  exceptional  cases,  a  peculiar  vibrator}-  sound — hydatid  fremitus. 
If  the  cyst  inflame,  violent  pains:  sometimes  compression  of  portal 
vein  or  vena  cava,  causing  ascites  and  oedema  of  legs. — Cyst  may  burst 
into  peritoneum,  causing  fatal  peritonitis:  or  into  base  of  lung,  hydatids 
and  puriform  matter  being  expectorated;  or  into  hepatic  duct,  whence 
contents  maj^  pass  through  common  duct  into  duodenum.  More  for- 
tunately- it  sometimes  bursts  directly  into  intestines,  or  through  ab- 
dominal wall.  May  also  undergo  spontaneous  cure,  without  rupture; 
by  secretion  of  thick  putty-like  matter  within  the  sac. 

Treatment.  Iodide  of  potassium,  31.  Calomel.  Common  salt.  Sul- 
phur baths.  Electricity.  Eemoval  of  fluid  contents  by  tapping.  Injec- 
tion of  solution  of  iodine,  or  diluted  alcohol,  after  tapping.  Insertion 
of  drainage-tube  after  tapping.  Careful  incision,  provided  cyst  be  ad- 
herent to  integuments. 

HEPATITIS. — From  "H-ap,  the  liver;  terminal  -itis.  Inflammation 
of  the  liver  lias  to  be  considered  under  five  heads:  (1)  Hepatitis,  or  in- 
flammation of  peritoneal  investment,  or  of  substance  of  the  gland,  or  of 
both  combined.  (2)  Cirrhosis,  or  that  slow  form  of  inflammatory  ac- 
tion which  affects  the  areolar  or  connective  tissue.  (3)  Syphilitic 
hepatitis.  (4)  Inflammation  of  the  bloodvessels.  (5)  Inflammation  of 
biliar}-  ducts  and  gall-bladders. 

1.  Hepatitis. — Synon.  Suppurative  Injiammation  of  Liver. — Occasion- 
ally, only  the  coats  of  liver  and  Glisson's  capsule  become  inflamed  (Peri- 
Hepatitis).  More  commonl}^,  substance  of  gland  attacked.  The  morbid 
action  mtiy  be  diffused  over  wdiole  organ  (Hepatitis  diffusa  parenchyma- 
tosa) ;  an5  it  may  lead  to  softening  and  acute  atrophy,  or  to  induration. 
Generally,  inflammation  more  circumscribed  (Hepatitis  vera  circum- 
scripta, suppuratoria) ;  and  then  aljscess  is  a  frequent  result. 

Symptoms.  Tenderness  over  gland:  most  marked  if  peintoneal  in- 
vestment be  affected.  High  fever,  sometimes  assuming  a  low  form. 
Fulness  of  right  hypochondrium :  increased  dulness  on  percussion. 
Pain  increased  by  pressure,  cough,  deep  inspirations;  inability  to  lie 
on  left  side.  Yellow  tinge  of  conjunctiva;  rarely  jaundice.  Dyspnoea, 
cough,  vomiting,  headache,  hiccup.  Pains  in  right  clavicle  and  shoul- 
der: probably,  when  left  lobe  of  liver  suffers,  pains  in  left  shoulder. 

Formation  of  abscess  signalized  by  chills,  or  distinct  rigors.  Hectic 
fever.  G-astric  disturbance.  Pain  and  great  tenderness.  Tension  of 
abdominal  muscles  on  pal2)ation.  Feeling  of  weight  about  liver.  Ema- 
ciation.    Prostration.     Diarrhoea  or  dj-senterj". 

Treatment.  Sulphate  of  soda  and  taraxacum,  14-4.  Aloes,  gentian, 
and  potash,  148.     Small  doses  of  blue  pill  and  ipecacuanha.     Acid  tar- 


138  HEPATITIS. 

trate  of  potash.  Salines,  848.  Opium.  Opium  and  ipecacuanha,  324. 
Opium  and  belladonna,  344.  Ipecacuanha,  morphia,  and  astringents 
where  there  is  dysentery.  Fomentations.  Compress  with  dilute  nitro- 
hydrochloric  acid  and  water. — Restricted  diet.  Indian  sarsaparilla  and 
harley  water  drink,  20.  Acid  tartrate  of  potash  drink,  356.  Complete 
rest  in  bed. 

If  svppuration  occur:  Bark  and  ammonia,  371.  Mineral  acids  and 
bark,  376.  Nitro-hydrochloric  acid,  378.  Quinine,  379.  Quinine  and 
steel,  380.  Opium.  "Wine.  Nourishing  food. — If  surface  of  abscess  have 
become  adherent  to  abdominal  parietes,  puncture  with  trocar  and  can- 
ula,  after  exploratory  punctui*e  with  grooved  needle.  Some  authorities 
prefer  allowing  abscess  to  burst  spontaneously. 

Remedies  sometimes  employed :  Tartarated  antimony.  Calomel.  Iodide 
of  potassium.  Colchieum.  Digitalis.  Bloodletting.  Leeches.  Blis- 
ters.    Issues. 

2.  Cirrhosis. — From  A't/>/5o<r,  yellowish  :  because  on  slicing  the  liver  it 
presents  the  grayish-yellow  color  of  impure  beeswax.  Synon.  Intersti- 
tial Hepatitis;  Granular  Induration  of  Lirer ;  Hob-nailed  Liver;  Gin- 
drinker's  Liver. — Chronic  inflammation  and  hypertrophy  of  areolar  tis- 
sue pervading  and  covering  liver.  The  gland  becomes  abnormally  firm, 
and  subsequently  contracted  ;  the  contraction  of  thickened  connective 
tissue  causing  the  capsule  to  be  drawn  in,  so  that  the  surface  of  the 
liver  has  a  "  hob-nailed"  appearance.  As  it  is  a  common  result  of  spirit- 
drinking,  it  is  sometimes  known  as  Gin-drinker's  liver. 

Symptoms.  Few  and  obscure  until  effused  fibrine  begins  to  interfere 
with  flow  of  portal  blood,  and  secretion  and  escape  of  bile.  Slight  en- 
largement of  gland  :  as  fibrous  tissue  contracts  and  lobules  atrophy,  the 
gland  diminishes  in  size.  Hypertroph}^  of  spleen.  Pain  in  right  h^-po- 
chondi'ium :  indigestion,  flatulence,  constipation:  occasional  feverish- 
ness:  drj- and  rough  skin  :  unhealthy  sallow  look.  After  an  interval, — 
debilit}"  with  loss  of  flesh.  An  increasing  contraction  of  eff'used  Ij-mph 
obstructs  portal  circulation, — ascites.  Jaundice.  Dilatation  of  veins  in 
abdominal  walls.  Hemorrhage  into  stomach  and  intestines.  Rarely, 
an  attack  of  hemorrhage  has  constituted  one  of  earliest  symptoms,  and 
caused  death  before  disease  has  been  suspected.  Increase  of  dropsical 
efl'usion.  Death  from  exhaustion;  or  from  some  intercurrent  attack  of 
pneumonia,  peritonitis,  jaundice  and  toxaemia,  or  diarrhoea. 

Treatment.  At  commejicement :  Disuse  of  all  alcoholic  drinks,  coffee, 
curr}",  and  highly  seasoned  dishes.  Plain  animal  food.  Sulphate  of 
magne.sia,  141.  Sulphate  of  soda,  143.  Resin  of  podophyllum.  160.  Acid 
tartrate  of  potash  and  taraxacum,  194.  Factitious  Carlsl)fd  waters, 
181.  Watersof  Carlsbad,  496.  Marienbad,  497.  Kreuznach,484.  Iodide 
of  potassium,  31.     Quinine  and  iodide  of  iron,  382. 

When  degeneration  of  hepatic  cells  has  far  advanced  :  Nitro-hydrochloric 
acid,  378.  Pepsine  and  nux  vomica,  420.  Rhubarb  and  bitters,  370. 
Inunction  of  hepatic  region  with  compound  iodine  ointment:  red  iodide 
of  mercury  ointment. 

For  checking  hemorrhage :  Gallic  acid,  103.  Turpentine,  50,  102.  Cin- 
namon and  nitric  acid,  104.  Aromatic  sulphuric  acid  and  opium,  100. 
Cold  drinks:  ice.     Bladder  of  ice  over  abdomen. 

For  ascites:  Squills,  digitalis,  and  juice  or  decoction  of  broom,  219. 
Buchu  and  cream  of  tartar,  222.  Nitre,  juniper,  and  nitrous  ether,  221. 
Solution  of  potash  and  digitalis.  220.  Benzoate  of  ammonia,  215.  Ela- 
terium.  157.  Calomel  and  jalap,  159.  Morphia,  chloroform,  and  Indian 
hemp,  317.     Tapping.     Nourishing  food:  milk,  raw  eggs,  stimulants. 

3.  Syphilitic  Hepatitis. — Generally  accompanied  with  other  tertiary 


HEPATITIS.  139 

symptoms  of  venereal  infection.  Three  varieties  :  (1)  Simple  interstitial 
hepatitis  and  pei'i-hepatitis.  (2)  Hepatitis  gummosa;  in  which  wliite 
depressions,  like  cicatrices,  are  found  to  contain  yellowish  nodules  of  a 
rounded  form  and  dried  appearance,  varying  in  size  from  a  linseed  to  a 
hcan.  And  (3)  as  waxy,  amyloid,  or  lardaceous  degeneration. — All 
three  forms  may  coexist,  or  either  may  be  present  independently  of  the 
others  (Frerichs). 

Symptoms.  Those  produced  by  first  and  second  varieties  seldom  very 
sti-iking:  while  one  portion  of  gland  becomes  unfit  for  its  functions,  the 
cells  of  healthy  part  get  hypertrophied.  Syphilitic  cachexia.  Enlarge- 
ment of  spleen.     Sometimes  albuminuria. 

T[iEATMENT.  lodidc  of  potassium,  31.  Corrosive  sublimate,  27.  Green 
iodide  of  mercury,  53.  Red  iodide  of  mercury,  54.  JMercui-ial  va])or 
bath,  131.  Nourishing  food.  Rest  from  mental  and  bodily  labor:  coun- 
try air.  Where  there  is  renal  disease, — iodide  of  iron,  32. — See  Hepatic 
Degenerations. 

4.  Diseases  of  Bloodvessels. — Hepatic  artery  and  its  branches  may  be 
involved  in  liver  disease. — in  cirrhosis,  cancer,  tubercle,  &c. ;  or  canal 
of  artery  may  become  obstructed;  or  there  may  be  atheroma  of  the 
coats,  or  aneurismal  dilatation. 

Portal  vein  may  have  its  channel  obstructed  by  coagnla. — Sometimes 
ru))tured,  from  fiatty  degeneration  of  coats. — Inflammation,  ulceration, 
or  suppuration  of  viscera  in  which  the  roots  of  this  vein  have  their 
oi'igin,  may  produce  suppurative  disease  of  vein  itself  Chief  featui-es 
of  suppurative  portal  phlebitis  are  headache,  violent  fever,  great  pros- 
tration, rigors,  profuse  sweating,  pains  in  epigastrium  or  right  h3"po- 
cliondrium,  bilious  diarrhoea,  jaundice,  enlargement  of  liver  and  spleen  ; 
followed  frequently  by  symptoms  of  peritonitis,  occasionally  by  metas- 
tatic purulent  deposits  in  liver  or  lungs  or  joints;  and  terminating  in 
fi\tal  exhaustion  or  coma.  Remedies  of  little  avail :  quinine  and  opium 
to  subdue  rigors  and  pain.  Milk  and  raw  eggs.  Solution  of  beef,  2. 
Demulcent  drinks,  19. 

Hepatic  veins  usually  found  enlarged  after  death  from  valvular  disease 
of  heart. — Rarely  the  seat  of  adhesive  inflammation. — Su])purative  he- 
patic phlebitis  more  common,  as  a  consequence  of  abscess  ot  liver.  Blood- 
poisoning  generally  ensues. 

5.  Inflammation  of  Biliary  Passages. — The  biliary  ducts  and  gall-blad- 
der may  be  attacked  b}-  different  forms  of  inflammation  :  (1)  Catarrhal 
inflammation,  in  which  secretion  of  mucus  is  increased  and  soon  be- 
comes viscid  or  muco-purulent.  Sometimes  the  cystic  or  common  duct 
becomes  temporarily  obstructed  by  a  firm  plug  of  mucus.  The  morbid 
action  generally  has  its  origin  in  catai'rh  of  stomach  and  duodenum. 
(2)  In  exudative  or  plastic  inflammation  there  is  either  a  firm  fibrinous 
or  a  croupal  product.  This  forms  casts  of  the  tubes,  blocking  them  up 
and  leading  to  dilatation.  ^3)  Suppurative  inflammation  leads  to  forma- 
tion of  pus  and  a  thick  kind  of  mucus  tinged  with  bile.  Ulceratiou 
may  occur:  ulceration  of  gall-bladder  often  found,  together  with  gall- 
stones :  may  be  induced  by  decomposing  bile,  where  there  are  no  calculi. 

Symptoms.  Verj^  variable  in  severity.  Cxall-bladder,  cystic  and 
common  ducts  more  obnoxious  to  inflammation  than  hepatic  ducts, 
because  the  former  are  more  likely  to  be  irritated  by  gall-stones  and 
unhealthy  bile. — In  catarrhal  inflammation,  there  is  slight  tendei-ness, 
tightness  about  epigastric  and  right  hypochondriac  regions,  nausea, 
mild  fever,  and  constipation.  Jaundice,  if  viscid  mucus  choke  up  many 
of  the  ducts;  ending  with  salutary  diarrhoea  as  pent-up  bile  finds  its 
way  into  duodenum.     Undue  retention  of  bile  in  gall-bladder,  from  any 


140  HERNIA. 

cause,  may  lead  to  decomposition  :  hence  irritation  and  inflammation, 
perhaps  ending  in  suppuration  and  ulceration  and  even  perforation. 

Dilatation  of  biliary  passages  may  occur,  from  their  origin  in  plexiform 
network  in  which  hepatic  cells  lie,  to  termination  of  common  excre- 
tory duct  of  liver  or  gall-bladder  in  duodenum.  Generally,  expansion 
only  partial.  In  any  case,  it  may  arise  from  habitual  accumulation  of 
inspissated  bile;  compression  of  ducts  by  tumors  or  bj-  disease  of  the 
parench^^ma ;  inflammatory  swelling  of  mucous  lining  diminishing 
calibre  of  tubes,  and  so  leading  to  retention  of  their  secretions  as  well 
as  of  bile;  and  from  obstruction  by  calculi,  catarrhal  or  croupy  exuda- 
tions, &c.  Owing  to  obstruction  of  duodenal  orifice,  the  ductus  com- 
munis choledochus  has  become  as  large  as  small  intestine.  When  the 
gall-bladder  cannot  get  rid  of  its  contents  in  consequence  of  occlusion  of 
cystic  duet,  the  residuary  bile  may  be  absorbed  ;  but  if  lining  membrane 
continue  to  secrete  mucus,  dropsy  of  cyst  must  result.  If  obstructing 
substance  act  like  a  valve,  permitting  ingress  of  bile  but  preventing 
egress,  a  large  pear-shaped  or  globular  tumor  may  form,  containing 
some  pints  of  fluid.  Rupture  of  bladder  has  been  pi'evented  by 
tapping:  can  be  safely  performed  provided  there  are  adhesions  to 
abdominal  wall. 

Treatment.  Active  remedies  have  probably  only  an  injurious  efl'ect. 
Recovery  may  be  aided  by  a  restricted  diet ;  warm  baths  ;  simi)le  a]^eri- 
ents  if  there  be  constipation;  astringents  if  there  be  undue  diarrhcea. 
Fomentations  and  sedatives  to  relieve  pain:  simple  diluents  or  salines 
for  fever  and  thirst:  digestible  restorative  food,  with  ammonia  and 
bark,  if  there  be  exhaustion. 

Where  catarrhal  inflammation  becomes  chronic,  and  customary  dis- 
charge of  bile  does  not  occur, — Nitro-hydrochloric  acid,  378.  Benzoic 
acid.  49.  Benzoate  of  ammonia,  215.  Hydrochlorate  of  ammonia,  60. 
AVaters  of  Carlsbad,  496.  Marienbad,  497.  Sellers,  489.  Ivissingen, 
498. 

Remedies  sometimes  employed:  Leeches  to  anus:  to  hepatic  region. 
Blisters.  Issues*  Calomel.  Blue  pill.  Taraxacum.  Resin  of  podo- 
phyllum. Tartarated  antimony.  Iodine.  Iodide  of  potassium.  Iodide 
of  zinc.  Xitrie  acid.  Purified  ox  bile.  Chlorine  baths.  Nitro-hj'dro- 
chloric  acid  baths.     Turkish  baths. 

HERNIA. — From  "Epvo-,  a  branch  or  sprout;  because  in  this  affection 
the  whole  or  part  of  an  organ  shoots  out  from  its  natural  position. 
Synon.  Rupture. — A  tumor  formed  by  the  protrusion  of  more  or  less  of 
a  viscus  from  its  normal  site.  Thus,  there  may  be  hernia  of  the  brain, 
cornea,  mucus  lining  of  windpipe  through  rings  of  trachea,  lung,  liver, 
spleen,  bladder,  uterus,  ovaries,  omentum,  and  intestine.  When,  how- 
ever, the  term  '•  hernia"  stands  alone  it  signifies  a  protrusion  of  omen- 
tum or  intestine  through  some  abnormal  opening  in  abdominal  walls; 
in  which  sense  it  is  here  considered.  The  viscera  most  liable  to  protru- 
sion are, — small  intestines,  omentum,  and  arch  of  colon.  The  most 
frequent  sites  are  those  points  where  muscular  and  tendinous  structures 
ar<«  weakened  to  allow  of  exit  of  spermatic  cord  in  male  and  round  liga- 
ment in  female,  or  of  large  vessels  to  lower  extremity, — inguinal 
and  crural  canals. 

A  hernia  is  composed  of  a  Sac  and  its  Contents.  The  sac  consists  of  a 
parietal  layer  of  peritoneum  :  is  always  present  save  in  hernia?  follow- 
ing penetrating  wounds,  in  some  cases  of  congenital  umbilical  hernia, 
and  in  cases  where  viscus  protruded  is  only  partially  covered  by  peri- 
toneum (as  the  Cfficum) ;  and  it  has  a  neck  which  is  often  the  seat  of 
constriction  in  strangulated  hernia,',  and  a  body  which  is  usually  pyi"i- 


HERNIA.  141 

form  or  globular.  When  the  sac  only  contains  intestine,  the  rupture  is 
termed  an  Enterocele;  when  only  omentum,  an  Epiplocele;  when  both, 
an  E7itero-epiploeele. 

A  hernia  is  at  first  Reducible, — the  contents  of  the  sac  can  generally 
be  pushed  back  into  abdominal  cavity,  though  the  sac  itself  i-apidly 
becomes  adherent  to  areolar  tissue.  After  reduction,  protrusion  is  to 
be  restrained  by  a  projier  truss, — a  pad  kept  over  the  seat  of  protrusion 
by  a  steel  spring  round  the  body.  Amongst  the  best  trusses  are  those 
of  Mr.  John  Wood;  contrived  so  as  to  exert  flat  and  level  pressure  at 
sides  of  hernial  opening  instead  of  in  the  axis.  Most  other  instruments 
have  convex  pads  which  exert  pressure  chiefly  on  centre  of  hernial  aper- 
ture, and  must  therefore  increase  its  size.  Bigg's  convolute  spring  truss 
sometimes  very  useful  in  oblique  inguinal  rupture.  A  radical  cui-e  may 
be  desirable  :  operations  for  eft'ecting  this,  either  aim  at  invaginating  the 
skin  and  superficial  fascia  and  sac,  so  as  to  plug  the  0])ening  through 
which  the  hernia  passes  (Wiitzer's)  ;  or,  after  invaginating  sac  and 
fascia,  the  sides  of  the  aperture  are  brought  together  by  sul)Cutaneous 
stitches,  and  held  so  until  sufficient  adhesive  inflammation  has  been  set 
\\\)  (John  Wood's). 

Irreducible  hernia, — protrusion  generally  large,  of  long  standing,  and 
often  consisting  of  thickened  omentum  and  of  intestine  and  mesentery. 
If  left  alone,  there  is  a  tendency  to  gradual  increase:  to  prevent  this, 
if  hernia  be  not  too  large,  it  may  be  supported  and  protected  by  a  truss 
with  a  large  concave  pad;  if  of  great  size,  a  suspensory  bandage  ought 
to  be  Avorn.  Inflammation,  simulating  strangulation,  sometimes  occurs 
in  these  hernia):  the  treatment  must  consist  in  use  of  opium,  fomenta- 
tions, and  perfect  rest. 

Incarcerated  hernia  is  an  irreducil)le  hernia  which  has  become  tempo- 
rarily obstructed,  from  accumulated  flatus  or  some  undigested  matters 
in  an  angle  of  the  gut.  The  constipation  is  to  be  removed  by  purgative 
enemata,  189,  191  :  ice  may  be  a])plied  :  the  taxis  to  be  used  to  empty 
incarcerated  gut  of  its  contents. 

Stra/ajidated  hernia  is  that  form  in  which  the  portion  of  protruded 
omentum  or  intestine  is  so  tightly  constricted  that  it  cannot  be  re- 
duced :  consequently  the  passage  of  fJBCes  is  arrested,  and  gangrene 
soon  occurs  if  relief  be  not  aftbrded.  The  symptoms  are  those  of 
obstruction  of  the  bowels.  The  treatment  consists  in  recourse  to  the 
taxis, — the  attem|)t  to  return  the  protrusion  by  manipulation,  without 
undue  force.  This  may  be  assisted  bj^  placing  the  patient  in  a  hot 
bath  ;  by  inducing  anaesthesia  with  chloroform  ;  by  a  full  dose  of  opium  : 
by  application  of  bladder  of  ice;  or  by  invei'ting  the  patient,  so  tiiat 
the  gut  niay  be  emptied  of  its  fluid  contents.  Some  practitioners  relax 
the  muscular  contraction  by  bleeding,. nauseating  doses  of  antimony 
or  tobacco,  large  enemata  to  empty  the  lower  bowel,  &c.  If  the  symp- 
toms continue  after  reduction,  they  may  be  due  to, — the  hernia  having 
been  pushed  back  en  masse,  sac  and  all;  or  there  may  have  been  a 
double  strangulation,  the  taxis  having  failed  to  relieve  the  stricture 
within  the  sac:  or  the  constriction  may  have  been  so  great  that  gan- 
grene has  been  set  up.  But  the  taxis  failing  to  effect  reduction,  one  of 
two  operations  becomes  necessary  without  delay: — an  incision  is  made 
over  the  neck  of  the  tumor,  the  sac  exposed  and  opened,  and  the  stric- 
ture divided  from  within;  or  the  sac  is  to  be  left  entire,  the  stricture 
being  divided  outside. 

The  special  hernife  are:  (1)  Oblique  inguinal  hernia,  in  which  the 
protrusion  originates  at  internal  abdominal  ring,  traverses  entire  length 
of  inguinal  canal,  and  usually  passes  out  at  external  ring. — (^2)  Direct 
inguinal  herrda  passes  through  a  triangular  space  on  inner  side  of  epi- 


142  HERPES — HICCOUGH. 

gastric  vessels,  bursting  through  or  pushing  before  it  the  conjoined 
tendon  of  internal  oblique  and  transversalis  muscles,  and  presenting  at 
external  ring  gradually  makes  its  way  into  scrotum  or  labium. — (3) 
Congenital  henna  descends  inside  the  tunica  vaginalis,  which  forms  its 
sac.  Always  oblique,  following  the  course  of  si^ei-matic  cord.  The 
tendency  to  the  protrusion  is  congenital,  but  the  actual  hernia  may  not 
occur  for  some  years  after  birth. — (4)  Femoral  or  crural  hernia  is  that 
wljich  escapes  under  Poupart's  ligament  through  the  crural  ring,  and 
enters  the  sheath  of  the  vessels  internal  to  tlie  femoral  vein.  After 
passing  through  the  saphenic  opening  of  the  fascia  lata  it  turns  up  over 
the  falciform  process,  instead  of  descending  on  the  thigh. — (5)  Umbilical 
hernia  protrudes  through  the  umbilical  aperture.  Not  uncommon  in 
infants,  and  in  women  who  have  borne  many  children. — (6)  Ventral 
herntce  are  such  as  protrude  through  any  part  of  the  abdominal  parietes, 
except  the  inguinal  or  femoral  or  umbilical  apertures.  Most  frequent 
through  the  linea  alba,  linege  semilunares,  &c. — (7)  Obturator  hernia 
passes  through  the  opening  in  obturator  ligament  which  gives  exit  to 
the  artery  and  nerve.  Very  rare,  and  very  difficult  to  diagnose  during 
life. — (8)  Ischiatic  hernia  escapes  through  the  sciatic  notch. — (9)  Peri- 
neal hernia  descends  between  rectum  and  bladder,  forming  a  pi'otru- 
yion  in  perineum. — (10)  Vaginal  hernia  gives  rise  to  a  tumor  which 
jjrotrudes  through  the  posterior  or  upper  wall  of  vagina. — (11)  Labial 
hernia  presents  a  tumor  in  one  of  the  labia  and  along  the  side  of  vagina. 
-^(12)  Diaphragmatic  hernia  results  from  a  wound  or  from  congenital 
detieiency  of  a  portion  of  the  diaphragm.  The  stomach  or  transverse 
colon,  with  a  large  portion  of  omentum,  may  escape  through  sucii  an 
opening  and  form  a  large  tumor  in  thoracic  cavity. 

HERPES. — From  "Ep-oj,  to  creep.  Synon.  Tetter. — A  transient  non- 
contagious skin  disease,  consisting  of  clusters  of  vesicles  upon  inflamed 
patches  erf  irregular  size  and  form.  Eruption  runs  a  definite  course ; 
with  one  exception,  rarely  continues  for  more  than  three  or  four  days; 
is  not  usually  severe;  and  leaves  no  scar. 

Varieties.  Herpes  labiaiis,  often  forms  on  upper  lip  during  a  cold. — 
Herpes  preputialis,  occurs  on  foreskin:  vesicles  run  into  each  other,  pro- 
ducing an  excoriation  covered  with  a  scab. — Herpes  zoster,  zona,  or 
shingles,  sometimes  very  troublesome:  frequentl}-  attended  with  sevei-e 
stinging  pain.  Inflamed  patches  with  their  clustered  vesicles,  arranged 
in  ibrm  of  a  band,  encircling  half  the  circumference  of  the  body.  May 
resist  treatment  for  a  few  weeks. 

Treatment.  Attention  to  bowels.  Regulation  of  diet.  Vesicles 
may  be  pricked,  and  sponged  with  warm  water  or  dilute  solution  of 
subacetate  of  lead.  Oxide  of»zinc,  or  subacetate  of  lead  ointment. 
Painting  with  belladonna  or  aconite  liniment,  where  there  is  pain.  In 
obstinate  forms,  quinine  and  arsenic,  52. 

HICCOUGH. — Synon.  Singultus;  Hiccup. — A  short  convulsive  and 
nt)isy  insjjiration,  followed  immediately  by  expiration.  It  is  due  to  the 
sudden  and  involuntary  and  momentary  contraction  of  the  diaphragm, 
with  a  simultaneous  narrowing  of  the  glottis.  Frequently  a  warning 
of  great  danger  in  severe  diseases:  often  a  symptom  of  irritation  or 
inflammation  of  the  digestive  organs:  occasionally  a  jDroduct  of  hys- 
teria: sometimes  a  mild  idiopathic  atfection.  Most  common  during 
infancy  and  old  age.  The  convulsive  inspirations  produce  pain  about 
the  prajcordia.  Paroxysms  of  hiccough  recurring  at  short  intervals, 
and  continuing  for  some  days,  are  occasionally  the  cause  of  great 
exhaustion. 


HOOPING-COUGH.  143 

Treatment.  Idiopathic :  In  inild  cases  hiccoui^h  may  pcrliaps  be 
checked  by  taking  a  set  of  deep  inspirations  and  then  holding  the 
breath  as  long  as  possible,  so  as  to  keep  the  diaphragm  contracted.  A 
belt  firmly  apjjlied  round  epigastrium.  Use  of  sternutatories  to  pro- 
voke prolonged  sneezing. — In  severe  forms, — Ammonia.  Musk.  Pep- 
permint. Camphor.  Ether.  Mulled  Port  wine,  or  hot  brandy  and 
water  with  spice.  Chloroform  on  sugar.  Aconite.  Belladonna.  In- 
halation of  chloroform  or  ether.  Opium.  Henbane.  Hydrocyanic  acid. 
Ice,  or  iced  water.  Blisters;  sinapisms;  turpentine  stupes;  dry  cup- 
ping; wet  compress;  belladonna,  aconite,  chloi-oform,  or  opium  lini- 
ment; either  agent  to  be  applied  to  back  and  sides,  in  neighborhood  of 
attachments  of  diaphragm. — Dyspeptic:  Emetics.  Mild  warm  ape- 
rients, or  enemata  of  castor  oil,  &c.  Draughts  of  ammonia,  bicarbonate 
of  potash,  and  peppermint  water.  White  bismuth.  Ci-easote.  Ipecac- 
uanha. Sinai)isms. — Hysterical:  Assafoetida.  SumbuL  Musk.  Vale- 
rianate of  ammonia,  quinine,  iron,  or  zinc.  Ferruginous  tonics.  Shower 
baths.  Galvanism. — Intermittent:  Quinine.  Arsenic. — Infantile:  Dill 
water  (aqua  anethi).  A  few  drops  of  brandy  in  hot  sugared  water. 
Warm  bath.    Attention  to  quantity  and  quality  of  milk  or  other  food. 

HOOPING-COUGH. — Synon.  Pertussis;  Tiissis  Convulsiva;  Broncho- 
cepluditis;  Chincough. — An  infectious  disease,  especially  of  childhood; 
rarely  occurring  more  than  once  in  same  individual.  Attended  with 
slight  fever  and  vomiting;  and  accompanied  at  first  by  catarrh,  and 
subsequently  by  a  peculiar  cough  which  occurs  in  paroxysms  at  uncer- 
tain intervals. — Duration,  from  two  or  three  weeks  to  as  many  months. — 
Probably  due  to  some  poison  affecting  pneumogastric  nei-ve.  Some- 
times epidemic. 

Symptoms.  After  a  latent  period  of  perhaps  six  days,  a  simple  febrile 
stage  of  eight  or  ten  or  twenty  days'  duration  :  sometimes  accompanied, 
but  usually  followed,  b}^  violent  paroxysms  of  coughing.  Hestlessness 
from  corj'za,  heat  of  skin,  oppression  of  chest.  As  fever  remits,  the 
cough  assumes  its  peculiar  shrill  sound  or  hoop.  Child  soon  learns  when 
each  paroxysm  is  commencing,  and  is  frightened.  Series  of  coughs  or 
expiratory  efforts  very  powerful :  suffocation  seems  about  to  set  in,  when 
relief  is  afforded  by  a  long-protracted  inspiratory  act,  the  rush  of  air 
through  glottis  causing  characteristic  crowing  or  hooping.  Directly 
after  fit,  patient  regains  courage;  soon  appears  wadl.  If  paroxysm  end 
in  vomiting,  there  is  a  craving  for  food  immediately  afterwards.  There 
may  be  two  or  three  pai'ox^'sms  in  a  day,  or  as  many  in  an  hour. 

Complications:  May  coexist  with  measles,  small-pox,  &e.  With  bron- 
chitis, pneumonia,  disordered  bowels,  sonie  head  attection. — Perhaps  the 
urine  occasionally  contains  sugar — pertussal  glucosuria. — When  cough 
is  very  severe  it  is  sometimes  accompanied  with  hemorrhage  from  nose 
or  mouth  ;  or  from  ears,  with  laceration  of  membrane  of  tympanum. 
Ecchymosis  of  conjunctivse,  common.  —  May  prove  fatal  by  causing 
pneumonia.  Convulsions.  Hydrocephalus.  More  frequently,  by  catar- 
rhal inflammation  of  bronchi,  with  collapse  of  a  portion  of  the  lung. 

Treatment.  Mild  cases:  Warm  clothing  :  flannel  or  chamois  leather 
jackets  next  the  skin.  Light  nourishing  food.  Mucilaginous  drinks. 
Confinement  indoors.  Friction  of  spine,  night  and  morning,  with  bel- 
ladonna and  soap  liniment,  281. 

3Iore  severe  forms:  Ipecacuan,  as  an  emetic,  if  bronchi  are  loaded  with 
mucus,  231.  Ammonia,  ipecacuan,  and  senega,  235.  Sulphate  of  zinc 
and  belladonna,  92.  Ammonia,  ether,  belladonna,  and  hydrocyanic  acid, 
86.  Bromide  of  ammonium,  37.  Spirit  of  chloroform.  Hydroc^-anic 
acid.     jS^itric  acid,  91.     Tincture  of  aconite  (min.  j — iij).     Opium,  338. 


144         housemaid's  knee — hydrocele  and  hematocele. 

Hj'drochlorate  of  ammonia.  Attention  to  bowels.  Belladonna  liniment 
to  spine,  281.  Confinement  to  one  room:  temperature  68°  F.  Flannel 
clothing.  Nutritious  but  easily  digested  food  :  milk,  cream,  fish,  eggs. — 
When  chronic :  Saccharated  carbonate  of  iron.  Cod-liver  oil.  Eemoval 
to  sea-side. 

Remedies  sometimes  recommended:  Tartarated  antimony.  Ipecacuan. 
Alum.  Arsenic.  Assafoetida.  Camphor.  CoflPee.  Colchicum.  Peroxide 
of  hydrogen.  Musk.  Lobelia  inflata.  Saccharated  carbonate  of  iron. 
Quinine.  Oxide  of  zinc.  Sulphur.  Sponging  fauces  and  glottis  with 
solution  of  nitrate  of  silver  (gr.  20  to  the  fi.  oz.).  Leeches  to  spine. 
Sinapisms  to  spine.  Tartarated  antimony  ointment.  Cold  shower  bath, 
in  chi'onic  stage. 

HOUSEMAID'S  KNEE.— Enlargement  of  bursa  over  patella,  the  re- 
sult of  pressure  and  inflammation  from  kneeling.  If  the  inflammation 
be  acute, — Leeches,  poultices,  evaporating  lotions,  and  rest  w411  be 
needed.  In  chronic  cases, — Iodine  liniment,  blisters,  ammoniac  and 
mercury  plaster,  diluted  red  iodide  of  mercury  ointment,  &c.  Wire 
setons.  Tapping  with  trocar,  followed  by  seton :  the  wires  or  threads 
to  be  left  in  until  free  suppuration  has  been  set  up.  If  there  be  slough- 
ing, a  free  incision  must  be  made  through  anterior  part  of  bursa. 

HYDREMIA.— From  "TSwp,  water;  ai;ia,  blood.  Watery  blood.— See 
Ancemia. 

HYDROCELE  AND  HEMATOCELE.— Hydrocele  (from  "ncop,  water ; 
x7jV.7j,  a  tumor)  consists  of  an  accumulation  of  serum  in  the  tunica  vagi- 
nalis, or  in  the  cord.  Hiiematocele  (^Al;j.a,  blood;  xrj^.jj')  is  an  extravasa- 
tion of  blood  into  tunica  vaginalis. 

1.  Hydrocele  of  Tunica  Vaginalis. — Synon.  Hydrops  Scroti ;  Hydrorchis. 
— May  result  from  injuries,  testitis,  and  many  causes. 

Symptoms.  The  scrotum  gradually  gets  distended  with  serum,  ujitil 
it  forms  a  smooth  and  pear-shaped  and  fluctuating  and  traiisiucent 
swelling.  The  testicle  may  be  felt  near  the  lovver  and  back  part:  the 
spermatic  cord  to  be  distinguished  free  at  neck  of  tumor.  The  fluid 
consists  of  pale  yellow  serum  :  average  quantity  ten  or  twelve  ounces. — 
In  congenital  hydrocoiQ  the  communication  between  the  tunica  vaginalis 
and  peritoneal  cavity  has  not  been  obliterated.  Apt  to  be  complicated 
with  congenital  hernia. — In  encysted  hydrocele  thei'e  are  one  or  more 
cysts  tilled  with  serum,  connected  with  the  testis  or  epididymis. 

Treatment.  Palliative:  Withdrawal  of  fluid  by  trocar.  Punctures 
wiih  a  grooved  needle:  fluid  escapes  from  tunica  vaginalis  into  scrotal 
areolar  tissue,  whence  it  is  absorbed.  Painting  with  iodine.  Friction 
with  diluted  red  iodide  of  mercury  ointment.  Radical  cure:  Tapping, 
with  injection  of  tincture  of  iodine  (fl.  drm.  j  to  water  iij),  allowing  the 
injection  to  remain.  A  moderate  amount  of  inflammation  is  set  up. 
which  does  not  subside  for  two  or  three  days.  This  plan  failing,  a  seton 
may  be  j)assed  through  the  sac, — two  or  three  threads,  or  a  tine  iron 
wire. — In  congenital  hydrocele  a  truss  to  be  worn,  so  as  by  pressure  to 
close  vaginal  process.  Iodine  to  scrotum.  Punctures  with  giooved 
needle.  Irritating  injections  inappropriate. — In  encysted  form,  recourse 
is  to  be  had  to  tapping  with  or  without  injection  ;  or  to  seton. 

2.  Hydrocele  of  Cord. — Serum  accumulates  in  areolar  tissue  of  cord: 
not  Common.  In  some  cases,  the  fluid  is  formed  in  a  distinct  cyst; 
which   may  either   be  a  new  formation,  or  a  portion  of  unobliterated 


HYDROCEPHALOID    DISEASE — HYDROCEPHALUS.  145 

vaginal  process  of  peritoneum.     Where  interference  is  needed,  the  best 
remedies  are  iodine  to  surface  of  enlargement.     Acupuncture. 

3.  Haematocele. — Synon.  A  Blood  Tumor. — May  be  due  to  injury; 
sometimes  arises  spontaneously.  The  tunica  vaginalis  gets  distended 
with  blood  :  perhaps  to  such  an  extent  as  to  compress  the  testicle  and 
produce  atrophy.  Eest,  pressure,  and  cold  lotions  sometimes  effect  a 
cure.  If  there  be  much  inflammation  it  may  be  necessary  to  turn  out 
the  clot  by  a  free  incision,  and  leave  the  cavity  to  granulate. 

HYDROCEPHALOID  DISEASE.  — From  "mvp,  water;  ysfaXij,  the 
head  ;  terminal  -ides.  Synon.  Spurious  Hydrocephalus. — The  early  ap- 
pearances somewhat  resemble  those  due  to  dropsy  of  the  brain.  A 
fatal  error  to  mistake  spurious  for  i*eal  hydrocephalus. 

Symptoms.  Weakly  children  the  subjects  of  this  affection.  Heavi- 
ness of  head.  Drowsiness.  Great  languor.  Unhealthy  stools.  Alarm 
at  strangers  and  slight  noises.  Freaks  of  temjjer.  Irregular  breath- 
ing. Coolness  of  skin.  Surface  of  fontanelle  depressed,  instead  of  raised 
as  in  dropsy. 

Treatment.  Pure  milk.  Strong  beef  tea,  or  finely  pounded  meat. 
Eaw  meat,  2.  Port  wine.  Bark.  Steel ;  especially  chemical  food,  405. 
Strict  avoidance  of  active  purgatives,  diuretics,  and  poor  diet. 

HYDROCEPHALUS. — From  "Tdiop,  water;  xefaXij,  the  head.  Synon. 
Hydrocranium ;  Hydrops  Capitis;  Water  on  the  Head;  Dropsy  of  the 
Brain. — Met  with  in  children  of  various  ages,  as  result  of  many  circum- 
stances. Often  congenital,  and  associated  with  some  cerebral  malfor- 
mation. Sometimes  the  precursor,  sometimes  result,  of  tubercular 
meningitis  :  in  this  case,  often  spoken  of  as  acute  hydrocephalus.  AVhen 
congenital,  or  when  arising  slowly  from  constitutional  causes,  it  is 
termed  chronic  hydrocephalus. 

Head  attains  a  great  size:  the  unossified  sutures  yield  readil}"  to 
pressure  of  fluid.  One  side  may  be  larger  than  the  other.  Bones  thin 
and  transparent :  meninges  thickened.  Serum  often  contained  in  lateral 
ventricles,  which  are  perhaps  expanded  into  one  large  cavity:  occa- 
sionally collected  in  sac  of  arachnoid,  compressing  brain.  Quantity  of 
fluid  varies  from  two  or  three  ounces  to  as  many  pints.  Essentiall}'  a 
disease  of  childhood,  yet  occasionally  adults  are  aftected. 

Symptoms.  Grenerally  commence  before  infant  is  six  months  old : 
may  exist  from  birth.  Child  takes  food  eagerly,  but  does  not  thrive: 
after  a  few  weeks,  extreme  wasting.  Appearance  remarkable:  ema- 
ciated body,  small  face,  with  a  large  globular  cranium.  Head  droops 
helplessly  on  one  side.  Intelligence  usually  enfeebled.  Irritability  and 
peevishness;  morbid  susceptibility  to  noise  and  light;  liability  to  epi- 
leptic convulsions;  great  muscular  weakness.  EoUing  movement  of 
eyeball:  perhaps  strabismus,  or  amaurosis.  Headache;  nausea;  con- 
stipation, with  dark-colored  offensive  stools.  Grinding  of  teeth.  Screams 
on  awaking. 

In  second  stage,  moi"e  stupor;  pallor;  slow^  pulse;  dilatation  or  con- 
traction of  pupils  ;  picking  of  nose  and  lips.  In  favorable  cases,  lethargy 
and  pallid  hue  and  irritability  gradually  subside.  Desire  for  food.  In- 
crease of  muscular  power.  Diminution  of  emaciation.  In  unfavorable 
examples,  excessive  prostration  and  rapidity  of  pulse.  Paralysis.  Coma 
or  convulsions  ending  in  death. 

Treatment.  Prophylactic:  Infiints  with  tendency  to  hydrocephalus 
to  be  reared  so  as  to  strengthen  constitution  as  much  as  possible.  Nour- 
ishing food  :  plenty  of  good  milk.     Salt  water  baths :  friction  of  skin. 

10 


146  HYDRONEPHROSIS — HYDROPHOBIA. 

Residence  in  pure  air:  sea  side.  Cod-liver  oil.  Only  the  most  gentle 
attempts  at  education. —  Curative:  Rhubarb  and  magnesia.  Syrup  of 
senna.  Castor  oil.  Mercur}^  and  chalk.  Plain  but  nourishing  food  : 
pure  milk.  Cod-liver  oil.  Glycerine.  Iodide  of  potassium.  Iodide  of 
iron.  Quinine.  Bark  and  hypophosphite  of  lime  or  soda.  Chlorate  of 
potash.     Sea  air. 

Compression  of  head  and  tapping  have  been  strongly  advocated. 
Compression  best  effected  by  bandaging,  or  bj^  application  of  strips  of 
soap  plaster  over  whole  of  cranium,  so  as  to  make  equal  pressure  on 
every  part.  Where  thei-e  are  no  symptoms  of  active  cerebral  disease, 
pressure  will  probably  do  good. — Puncture  is  performed  with  a  small 
trocar  and  canula  at  coronal  suture,  about  an  inch  and  a  half  from  an- 
terior fontanelle,  so  as  to  avoid  longitudinal  sinus.  The  fluid  is  to  be 
evacuated  slowly;  as  much  as  will  flow  may  be  allowed  to  come  away; 
and  gentle  pressure  must  be  kept  up  both  during  its  escape  and  aflei-- 
wards  for  some  weeks.  Only  to  be  had  recourse  to  when  other  means 
have  failed.    Has  proved  successful  in  very  young  children. 

Remedies  sometiynes  used :  Active  purgatives.  Leeches.  Blisters.  Calo- 
mel. Corrosive  sublimate.  Mercurial  inunction.  Crude  mercury,  with 
manna  and  squills.  Tartarated  antimony.  Iodine.  Colchicum.  Digit- 
alis. Liquor  potassas.  Acetate  of  potash  and  squills.  Cold  attusion. 
Issue  in  neck,  or  on  each  shoulder. 

HYDRONEPHROSIS.— From  "r5a>/>,  water;  v£^/)o?,  the  kidney.  Synon. 
Mydrorenal  Distension;  Dropsy  of  the  Kidney. — May  result  from  obstruc- 
tion of  ureter  by  calculi,  tubercular  or  malignant  deposit,  pressure  of 
tumors,  &c.  Kidney  ultimately  converted  into  a  large  pouch.  Occa- 
sionally associated  with  suppuration  of  lining  jnembrane  of  pelvis  and 
calyces. 

Symptoms.  Sometimes  altogether  absent;  especially  if  distension  be 
not  very  great,  and  other  kidney  remain  healthy.  Hydronephrotic 
tumor  found  in  loin,  reaching  forwards  in  abdomen  ;  may  be  very  large, 
with  undulating  feel  and  fluctuation,  and  tender  to  touch.  Urine  often 
natui-al  in  quantity:  contains  pus  if  there  be  associated  pyelitis.  Sup- 
pression of  urine  and  uraemia  where  both  glands  are  affected.  Attacks 
of  nephritic  colic  where  there  is  a  calculus. 

Treatment.  Rest.  Diluents,  to  prevent  concentration  of  urine. 
'Gentle  and  oft-repeated  manipulation,  if  there  be  an  absence  of  tender- 
ness, so  as  to  force  onwards  obstructing  body.     Tapping. 

HYDRO-PERICARDIUM. — From  "Ydwp,  water;  nepcxdpScov,  the  peri- 
(Cardium.  Synon.  Hydropericarditis ;  Hydrops  Pericardii;  Ilyd.rocardia  ; 
Dropsy  of  the  Periqardium. — See  Pericarditis. 

HYDROPHOBIA.— From  "r^w/),  water;  <po6iw,  to  dread.  Synon.  Phobo- 
dypson;  Rabies;  Canine  Madness. — A  disease  caused  by  inoculation  with 
the  saliva  of  a  rabid  animal.  Period  of  incubation  varies  from  thirty 
.days  to  many  months.  Death  often  occurs  before  the  end  of  fourth  day 
from  commencement  of  symptoms. 

Symptoms.  Cramps  of  muscles  of  pharjnix  and  thorax.  Spasmodic 
action  of  diaphragm.  Great  dread  of  fluids.  Recurrence  of  paroxA^sms 
of  phrenzy  on  attempting  to  drink,  or  on  exposure  to  a  current  of  air. 
A  flow  of  viscid  saliva  ("  hydrophobic  slaver").  Restlessness.  Anxiety. 
Delirium.     Exhaustion. 

Treatment.  Prophylactic:  Suction  of  wound.  Excision  of  bite.  Ex- 
posure of  wound  to  stream  of  water.  Nitrate  of  silver.  Caustic  potash. 
Actual  cautery. 


HYDRORACHIS — HYPOCHONDRIASIS.  147 

Curative:  Chloroform.  Belladonna.  Subcutaneous  injections  of  liquor. 
Atropia?.  Hydrocyanic  acid.  Indian  hemp.  Wourali.  Ice.  Opium. 
Curara.  Sulphite  or  hyposulphite  of  soda  or  magnesia.  Vinegar.  Va- 
por baths.  Iodide  of  potassium.  Laying  open  cicatrix,  and  inducing 
suppuration.  Division  of  nerves  leading  to  wound.  Application  of  ice 
to  spine.     Transfusion  of  blood.     Copious  eneniata  of  plain  water. 

Remedies  which  have  been  eynployed  :  Venesection  to  syncope.  Cupping 
at  nape  of  neck.  Morphia  injections  into  veins.  Vaccination.  Strychnia. 
Galvanism.  Arsenic.  Iron.  Turpentine.  Tobacco.  Calomel.  Injec- 
tions of  warm  water  into  veins. 

HYDRORACHIS. — From  "Tdojp,  water;  /i«/£T,  the  spine.  Synon. 
HydrorThachia  Myelochysis ;  Hydrocele  Spinalis;  Dropsy  of  the  Spine. — 
The  serous  effusion  is  either  within  the  spinal  canal,  or  in  a  sac — spina 
bifida. 

Usually  congenital.  When  fluid  has  been  present  for  some  time,  the 
pressure  produces  atrophy  of  cord. — See  Spina  Bifida. 

HYDROTHORAX. — From   "Tdiop,  water;  Owpa^,  the    chest.     Synon. 

Hydrops  Thoracis;  Pleurorrhcea  Serosa  ;  Dropsy  of  the  Chest. — An  effusion 
of  serum,  or  of  serum  mixed  with  blood,  into  the  cavity  of  the  pleura. 
A  result  of  inflammation. — See  Pleurisy. 

HYPER.ffiMIA. — From  'T-kp,  in  excess  ;  mpa,  blood.  Synon.  Plethora  ; 
Polyceinia. — An  excess  of  blood  ;  or,  a  superabundance  of  red  corpuscles, 
producing  superfluous  richness,  without  any  increase  of  the  other  com- 
ponents. 

Symptoms.  Lassitude.  Indolence.  Desire  for  sleep.  Snoring  and 
dreaming.  Vertigo.  Hemorrhage.  Distended  capillaries.  Full,  strong, 
resistent  pulse.     Turgidity  of  veins. 

Treatment.  Restricted  diet:  non-nutritious  substances.  Active 
exercise.  Saline  purgatives,  165,  167,  169.  Bromide  of  ammonium,  87. 
Liquor  potassfe,  73.  Liquor  arsenicalis.  Mercury.  Tartar  emetic. 
Bloodletting.  Issues.  Mineral  waters  of  Cheltenham,  461.  Vichy,  479. 
Friedrichshall,  495. 

Abstinence  from. :  Beer;  wine;  spirits;  sugar;  milk;  fatty  matters. 
Lessened  amount  of  sleep. 

HYPERMETROPIA. — From  'Tr^kp,  in  excess  ;  fj.hpnv,  measure ;  and  co(/>, 
the  eye.  S3'non.  Over-sight. — That  condition  in  which  the  refractive 
power  of  the  eye  is  too  low,  or  the  optic  axis  (antero-posterior  axis)  too 
short.  Consequently  when  the  eye  is  in  a  state  of  rest,  parallel  rays 
are  not  united  upon  the  retina,  but  behind  it,  and  only  convergent  rays 
are  brought  to  a  focus  upon  the  latter  (Soelberg  Wells). 

Symptoms.  A  sense  of  heat  and  fulness  about  the  eyes  on  reading: 
the  print  appears  indistinct,  and  the  words  seem  to  run  into  each  other. 
Distant  objects  not  seen  clearly.  Eyes  look  smaller  and  flatter  than  in 
health.     Dull  frontal  headache. 

Hypermetropia  is  one  of  the  causes  of  asthenopia,  as  well  as  of  con- 
vergent strabismus.     Sometimes  associated  with  presbj^opia. 

Treatmei<jt.  Carefully-selected  convex  spectacles.  Glasses  increasing 
in  power  will  have  to  be  gradually  used  until  the  hypermeti'opia  is  com- 
pletely neutralized. 

HYPOCHONDRIASIS. — From  "Y-KoxovSpiaxo^^  affected  in  the  viscera 
under  the  false  ribs, — because  such  affection  was  regarded  as  the  cause 
of   melancholy.      Synon,  Hallucinatio  Hypochondriaca ;  Anathymiasis  j 


148  HYPOSPADIAS    AND    EPISPADIAS — HYSTERIA. 

Spleen;  Vapors ;  English  Malady ;  Low  Spirits. — May  be  said  to  consist 
prominently  of  an  exaggerated  egoism. 

Symptoms.  Frequently  functional  derangement,  occasionally  .struc- 
tural disease,  of  certain  organs,  especially  of  those  connected  with  func- 
tions of  nutrition  and  generation.  Hypochondriacs  writhe  under  des- 
potism of  imaginar}'  evils.  They  fullil  their  duties  naturally,  at  least 
for  a  time,  but  art;  morbidly  sensitive  of  opinions  and  actions  of  others. 
Constantly  dwelling  on  their  miserable  condition.  Dread  of  internal 
disease,  impotence,  insanity,  death.  Want  of  resolution.  Languid  cir- 
culation. Decayed  teeth.  To  same  extent  that  hysteria  is  peculiar  to 
female,  is  hypochondriasis  to  male  sex. 

Treatment.  Purgatives  injurious  as  a  rule.  Action  of  bowels  to  be 
maintained  by  exercise  and  proper  diet.  Narcotics  and  sedatives  in- 
crease the  mischief,  and  check  secretions.  If  there  be  anamia,  quinine 
and  steel,  379.  Strychnia,  or  nux  vomica,  387,  407,  408.  Phosphate  of 
zinc  and  bark,  414.  Hypophosphite  of  soda,  or  lime,  419.  Phosphate 
of  iron,  405.  Nitro-hydrochloric  acid.  378.  Sulphate  of  manganese. 
Cod-liver  oil.  Assafcetida.  Musk.  Sumbul.  Shower  bath.  Sea-bathing. 
Turkish  bath.  Nourishing  food.  Exercise  in  open  air.  Physical  train- 
ing.    Gymnastics. 

HYPOSPADIAS  AND  EPISPADIAS.  —  Hypospadias  QY-b,  under; 
ff-rKw,  to  draw  from )  is  a  congenital  malformation,  in  which  the  urethra 
opens  on  under  surface  of  penis  instead  of  at  extremity  of  the  glans. — 
Epispadias  ('£'-'£,  upon;  and'^u))  is  that  condition  in  which  urethra  ter- 
minates on  dorsum  of  penis.  Either  state,  when  extensive,  ma_y  call 
for  an  attempt  at  cure  by  a  plastic  operation.  Actual  cautery  some- 
times succeeds:  galvanic  cautery  wire. 

HYSTERIA. — From  'Yfrripa,  the  womb  ;  owing  to  its  supposed  origin 
in  this  organ.  Synon.  Hysteropathia ;  Asthma  Uteri;  Vapores  Uterini; 
Passio  Hysterica;  Hysterics. — A  nervous  disorder  which  occurs  in  par- 
oxysms, or  simulates  other  diseases.  Attacks  accompanied  with  an 
abundant  secretion  of  urine  of  low  specific  gravity-:  frequently  with  a 
sense  as  of  a  ball  rising  in  the  throat  (globus  hystericus).  Occasionally 
convulsions.  Women  from  the  age  of  puberty  to  the  decline  of  men- 
struation most  liable  to  it;  though  occasionally  men  are  the  subjects 
of  it. 

Symptoms.  Those  characterizing  hysteric  paroxysm  or  fit  are :  Con- 
vulsive movements  of  trunk  and  limbs;  beating  of  breasts  with  hands 
clenched,  or  tearing  of  hair  or  clothes;  shrieks  and  screams,  violent 
agitation  ;  globus  hystericus,  or  feeling  of  sufibcation  ;  attack  ending 
with  convulsive  outbreaks  of  crying  or  laughter,  and  sometimes  with 
hiccough.  Occasionally,  patient  falls  to  ground  insensible  and  ex- 
hausted :  soon  recovering,  tired  and  crying.  Perhaps  urine  is  discharged 
involuntarily  during  the  excitement. 

Hysterical  paraplegia,  or  hemiplegia,  sometimes  occurs.  There  may 
be  hyperaesthesia,  or  increased  sensibility  of  various  tissues,  perhaps 
leading  to  erroneous  susjjicions  of  pleurisy,  spinal  disease,  metritis,  or 
ovaritis.  The  opposite  condition — anjcsthesia,  or  loss  of  sensibility — not 
uncommon  ;  sometimes  lasting  for  many  months,  affecting  left  side  more 
than  right,  and  being  so  deep  that  pins  and  needles  may  be  thrust  into 
substance  of  affected  muscles  without  causing  pain.  Appetite  for  food 
increased,  or  diminished,  or  depraved  so  that  most  extraordinary  sub- 
stances ai*e  eaten. 

Hysteria  simulates  almost  all  diseases.  The  favorite  are :  Suppi'es- 
sion  of  urine,  stone  in  bladder,  pleurisy,  consumption,  complete  loss  of 


ICHORH^MIA — ICTERUS.  149 

voice,  paral^ysis,  epilepsy,  and  affections  of  spine  or  joints.  Ilj'sterical 
cough,  hiccough,  or  vomiting  may  prove  very  obstinate.  Peculiar  ex- 
pression of  countenance:  fulness  of  upper  lip,  drooping  of  upper  eye- 
lids. Questions  answered  abruptly.  Pains  increased  b}'^  pretended 
pressure.  Catamenia  often  irregular:  more  or  less  profuse  leucorrhoea. 
— Sufferings  not  alwa3'8  feigned.  Perhaps  generally,  patient  believes 
she  is  grievously  affected.  Even  where  pins  are  thrust  under  skin, 
stones  placed  in  vagina,  or  food  refused  unless  it  can  be  obtained  sur- 
reptitiously, the  patient  is  diseased.  She  resorts  to  these  practices  to 
increase  sympathy  of  friends. 

Treatment,  ijuring  paroxysm :  Loosen  dress.  Prevent  self-injury. 
Surround  body  with  cool  air.  Ammonia  to  nostrils.  If  it  can  be  swal- 
lowed, a  draught  containing  a  drachm  of  ammoniated  tincture  of  vale- 
rian. If  apparent  insensibility  continues,  cold  water  douche  over  head 
and  face. 

In  other  forms,  or  during  intervals  between  fits :  Aloetic  aperients,  156, 
39.3,  404.  Quinine  and  steel,  380.  Steel  and  glycerine,  392.  Strychnia 
and  steel,  408.  Zinc  and  iiux  vomica,  409.  Valerianate  of  zinc,  or  am- 
monia, or  steel,  or  quinine,  410.  Phosphate  of  iron,  405.  Hypojihos- 
phite  of  soda,  419.  Bromide  of  potassium,  42.  Cod-liver  oil.  Ammo- 
niated tincture  of  valerian  and  bark.  Compound  pill  of  assafoetida. 
Nourishing  food.  Exercise  in  open  air.  Mental  occupation.  Shower 
baths.  Sea  bathing.  Galvanism.  Attention  to  uterine  functions; 
checking  catamenia  if  too  abundant,  promoting  them  if  too  scanty. — 

See  Bed  Case. 

■* 

ICHORH^MIA. — From '//<«/),  pus ;  at/jia,  blood.  Synon.  Septicceinia ; 
Pijcemia  ;  Pyohcemia. — A  morbid  condition  of  the  blood,  caused  by  the 
introduction  of  ichorous  or  putrid  matters. 

Symptoms.  Shivering.  Sweating.  Eapid  pulse.  Epileptiform  seizures. 
Sweet  hay-like  odor  of^  the  breath.  Diarrhoea.  D3'sentery.  Pleurisy. 
Pericarditis.  Peritonitis.  Erysipelas.  Boils.  Secondary  abscesses. 
Rapid  wasting.  Feebleness.  Death  from  prostration.  In  chronic  cases 
the  symptoms  come  on  much  more  gradually,  and  are  less  intense. 

Treatment.  Calomel?  Aperients.  Vapor  bath.  Wet-sheet  pack- 
ing, 130.  Acid  sponging,  138.  Perfect  ventilation  of  sick-room.  Beer. 
Wine.  Brand}-.  Beef  solution,  2.  Essence  of  beef,  3.  Bark  and  am- 
monia, 371.  Quinine,  379,  386.  Sulphurous  acid.  Sulphite  of  mag- 
nesia, 48.  Mineral  acids,  376,  377.  Opium.  Cold  drinks.  Wenham 
Lake  ice.     Fomentations.    Poultices.    Incisions.    Leeches?    Bleeding? 

ICHTHYOSIS. — From  '//^/yc,  a  fish.  Synon.  Xeroderma  Ichthyoides; 
Fishskin  Disease. — A  very  rare,  non-contagious,  squamous  skin  disease. 
Characterized  by  development,  on  one  or  more  parts  of  body,  of  thick 
and  hard  and  dry  imbricated  scales  of  dirty  gray  color.  Unattended  by 
beat  or  pain  or  ilching.  The  scales  or  shagreen-like  flakes  give  rise  to 
most  unsightly  appearance. 

Treatment.  Internally:  Arsenic,  52.  Donovan's  triple  solution,  51, 
Red  iodide  of  mercury  and  arsenic,  55.  Cod-liver  oil.  Corrosive  sub- 
limate.    Solution  of  potash  in  sarsaparilla. 

Locally :  Warm  baths.  Alkaline  baths.  Vapor  baths.  Creasote 
lotions.  Glycerine.  Cod-liver  oil.  Neat's  foot  oil.  Friction  with 
olive  oil. 

ICTERUS. — From  "Ixrepo^,  a  yellow  bird  (probably  the  Loriot)  ;  be- 
cause the  color  of  the  plumage  resembles  that  of  the  skin  in  jaundice. 


150  IMPETIGO — IMPOTENCE   AND    STERILITY. 

Synon.  Morbus  Arcuatus  ;  Morbus  Begins  ^  Cholcemia  ;  Fellis  Superfusio. — 
See  Jaundice. 

IMPETIGO — From  Jmpefo,  to  attack;  terminal -?"^o.  Synon.  Psydra- 
cia ;  (■rusted  or  Bunning  Scall ;  Pushdar  or  Humid  Tetter. — A  severe, 
sometimes  eonta<ii;ioiis,  inflammation  of  the  skin  ;  characterized  by  an 
eruption  of  small  hemispheroidal,  or  flattened  pustules,  most  frequently 
grouped  in  clusters,  and  forming  thick  yellowish  scabs  or  incrustations. 
From  beneath  incrustations  a  discharge  flows:  crusts  get  thicker  and 
larger,  and  fall  off,  leaving  raw  surfaces. 

Varieties.  Impetigo  figurata  occurs  generally  on  face,  especially  the 
cheeks.  Attended  with  constitutional  disturbance,  and  swelling  of  lym- 
phatic glands.  Pustules  arranged  in  round  or  oval  groups:  as  they 
burst  and  form  scabs,  heat  and  itching  become  intolerable.  In  chil- 
dren, impetiginous  eruption  sometimes  covers  head  or  face  like  a  mask, 
and  is  called  crusta  lactea  :  sometimes  due  to  pediculi.  Impetigo  sparsa 
characterized  by  scattered  pustules ;  perhaps  irregularly  distributed 
over  a  limb,  or  even  entire  body. 

Treatment.  Internally :  Quinine,  379.  Quinine  and  steel,  380.  Arse- 
nic, 52,  3«1.  Eed  iodide  of  mercury  and  arsenic,  55.  Cod-liver  oil. 
Steel  and  aloes,  154.  Steel  and  sulphate  of  magnesia,  166.  Potash  and 
lime-water,  73.  Iodide  of  potassium.  Colehicum.  Plain  nourishing 
food. 

Locally :  Yapor  or  warm  water  baths.  Conium  and  starch  bath,  122. 
Hj-drocyanic  acid  lotion,  263.  Subacetate  of  lead  and  glycerine  lotion, 
264.  Creasote  lotion,  270.  Oxide  of  zinc  ointment.  Use  of  linen 
dipped  in  melted  suet.  Lime  liniment.  Creasote  and  red  oxide  of  mer- 
cury ointment,  301.  Diluted  citrine  ointment,  305.  Nitrate  of  silver. 
Iodine.  Borax.  Sulphur.  Hairs  to  be  cut  close  to  scalp,  if  head  or 
beard  be  attacked.     Early  puncture  of  pustules. 

IMPOTENCE  AND  STERILITY. — The  term  Impotence  (from  7n,neg.; 
possum,  to  be  able)  n)ay  be  applied  to  every  morbid  state,  in  either  sex, 
which  prevents  the  seminal  fluid  of  the  male  coming  into  contact  with 
the  female  ovule. — On  the  other  hand.  Sterility  (from  lTclpo<;,  barren)  is 
that  condition  in  which  either  no  spermatozoa  or  ovules  are  secreted, 
or  their  vitality  is  immediately  destroyed. 

1.  Impotence  in  Man. — The  act  of  copulation  may  be  rendered  impos- 
sible by  many  causes:  By  absence,  or  want  of  development,  or  malfor- 
mation, or  mutilation  of  penis. — By  mental  influences, — violent  emotion, 
passion,  over-excited  desire,  want  of  confldence,  anxiety,  grief,  disgust: 
this  form  most  curable,  by  tact  and  skill  on  part  of  physician  (see 
Montaigne's  Essays,  Book  I^chap.  xx). — By  fevers  and  other  severe  dis- 
eases, sexual  organs  remaining  feeble  after  general  health  is  restored : 
curable  by  ferruginous  tonics,  nux  vomica,  sumbul,  cantharides,  Indian 
hemp,  hypophosphite  of  lime  or  soda,  sea  bathing,  nourishing  food,  and 
stimulating  liniments  or  gentle  galvanism  to  spine. — By  injuries  to  back 
part  of  head, — from  falls,  blows,  railwaj^  accidents,  &c. ;  there  being 
generally  incurable  loss  of  power  and  wasting  of  testes  and  penis. — By 
injuries  and  diseases  of  spinal  cord  ;  which  remove  the  power  to  copu- 
late, though  desire  remains  and  semen  may  be  secreted. —  By  excessive 
use  of  tobacco,  which  impairs  digestion  and  weakens  nervous  and  mus- 
cular systems:  opium-eating  injurious  in  same  way. — By  abuse  of  sexual 
functions  removing  the  power  of  erection, — onanism,  excessive  inter- 
course (see  Spermatorrhoea). — Impediments  to  escape  of  semen;  such  as 
stricture  of  urethra,  in  which  ejaculated  fluid  regurgitates  into  bladder. — 


INDIGESTION — INFLAMMATION.  151 

Abnormal  openings  in  urethra  (hypospadias  and  epispadias),  bo  that  the 
semen  is  not  ejaculated  into  vagina. — By  excessive  obesity;  large  scrotal 
herniffi. 

2.  Impotence  in  Woman. — May  be  due  to :  Firm  adhesions  of  labia 
pudendi — Excessively  developed  and  persistent  hymen. — Absence,  mal- 
formation, or  an  impervious  condition  of  vagina  (see  Vaginal  Occhision). — 
Obliteration  of  this  canal  through  inflammation. — A  double  vagina  im- 
pedes but  does  not  prevent  copulation. — Super.sensitiveness,  with  spas- 
modic closure  of  vagina  (see  Vaginismus). — Tumors  of  vagina,  or  uterine 
tumors  which  have  passed  into  vaginal  canal. — Elongation  of  cervix 
uteri.  Engorgement,  or  induration,  of  labia  uteri.  Obliteration,  ob- 
struction, or  great  narrowing  of  os  uteri  or  cervical  canal:  closure  of 
uterine  cavity  by  tumors,  cancer,  ka. — Malpositions  of  uterus, — acute 
retroflexion  and  anteflexion. — Inflammatory  affections  of  uterus. — Oc- 
clusion of  Fallopian  tubes:  disease  of  their  fimbriated  extremities. — 
Irremediable  procidentia  of  uterus. — Large  vesico-vaginal,  or  recto- 
vaginal fistulas,  or  complete  rupture  of  perineum,  allowing  impro])er 
escape  of  seminal  fluid. — Uterine  cancer,  even  when  vagina  is  involved, 
impedes  but  does  not  prevent  intercourse  and  fecundation. 

3.  Sterility  in  Man. — Arises  from  :  Certain  diseases,  as  tuberculosis, 
diabetes,  albuminuria,  some  forms  of  obstinate  dyspepsia:  in  advanced 
stages,  secretion  of  seminal  fluid  usually  stopped. — Some  cerebral  de- 
fect, owing  to  which  the  functions  of  testicles  have  never  been  called 
into  play. — Diseases  of  testicles, — tumors,  cancer,  repeated  attacks  of 
inflammation,  and  varicocele;  though  as  only  one  gland  is  usually 
affected,  these  conditions  rarely  produce  sterility. — Malposition  of  testes, 
these  organs  being  retained  in  abdominal  cavity ;  cojjulation  being  fea- 
sible with  these  cryptorchics,  but  the  semen  ejaculated  being  destitute 
of  spermatozoa. — Obstructions  in  the  excretory  ducts  of  testicle;  such 
as  temporary  or  permanent  obstruction  after  epididymitis,  power  of 
copulating  remaining  but  ejaculated  fluid  being  destitute  of  sperma- 
tozoa.— Obliteration  of  ejaculatory  canals  from  abscesses  near  prostate, 
leading  to  atrophy  of  testes. — Abuse  of  tobacco  and  opium  and  alco- 
holic drinks,  as  well  as  a  syjjhilitic  taint,  may  destroy  vitality  of  sper- 
matozoa. 

4.  Sterility  in  Woman. — Arises  from  :  Amenorrhoea. — Exhaustion  or 
excessive  general  weakness. — Too  frequent  or  imperfect  sexual  excite- 
ment.— Indifference  to  sexual  act,  or  a  restraint  of  the  orgasm  ? — Ab- 
sence, arrest  of  development,  or  disease  of  ovaries;  only  a  relative,  not 
absolute  cause,  as  both  glands  are  seldom  diseased  at  same  time. — Leu- 
corrhoea,  especially  where  the  discharge  is  abundant  and  acrid;  by  caus- 
ing destruction  of  the  spermatozoa  before  they  reach  an  ovule. — Syph- 
ilitic taint  occasionally  destroys  vitality  of  ovules. 

For  the  treatment  of  impotence  and  sterility  refer  to  the  different  dis- 
eases of  the  sexual  organs  under  their  appropriate  heads. 

INDIGESTION. — From  In,  neg;  digero,  to  concoct  or  digest. — See 
Dyspepsia. 

INFLAMMATION. — From  In/lammo,  to  burn.  Synon.  Phlogosis ; 
Phlegmasia ;  Myperhmmatosis ;  Hyperendosmose. — Sometimes  a  destruc- 
tive, sometimes  a  formative  process;  consisting  essentially  of  local 
congestion  and  stagnation  (stasis)  of  blood,  with  exudation  of  liquor 
sanguinis. 

Symptoms.  Pain.  Swelling.  Heat.  Redness.  Blood  when  drawn 
becomes  buffed  and  cupped.    Diminution  of  red  corpuscles,  and  increase 


152  INFLUENZA INSANITY. 

of  fibrine:  perhaps  an  increase  of  colorless  corpuscles.  Eise  in  tempera- 
ture of  the  blood.  Symptomatic  fever.  Depression.  Eigors.  Frequency 
of  pulse.  Headache.  Thirst.  Loss  of  appetite.  Furred  tongue. 
Diminution  of  chlorides  in  the  urine.  Increased  excretion  of  urea. 
Sweating.  Hectic  fever.  Hemorrhage.  Adbesive  inflammation. 
Suppuration.  Ulceration.  Sloughing.  Gangrene.  Excessive  wasting. 
Prostration. 

Treatment.  Generally:  Withdrawal  of  cause.  Eepose.  Well- 
ventihited  sick-room.  Light  diet.  Ice  and  cold  drinks.  Tea.  Milk. 
Belladonna.  Henbane.  Aconite.  Opium.  Salines,  348,  349,  351,  &c. 
Aperients.  Acid  tartrate  of  potash.  Citrate  of  potash.  Colchicum. 
Carbonate  of  ammonia.     Wine  or  brandy. 

Locally:  Fomentations.  Poultices.  Water  dressing.  Ice.  Evapo- 
rating lotions.     Baths.     Sinapisms.     Turjientine  stupes. 

Antiphlogistic  remedies:  Bleeding.  Leeches.  Cujoping.  Emetics. 
Drastic  purgatives.  Antimony.  Mercury.  Digitalis.  Veratrum  viride. 
Blistei'S.     Setons.    Issues.     Low  diet. 

INFLUENZA. — From  the  Italian,  Influenza  ;  because  the  phenomena 
were  thought  to  be  due  to  the  influence  of  the  stars.  Synon.  Rheuma 
Epideniicum ;  Defluxio  CatarrhaUs;  Epidemic  Catarrhal  Fever ;  La  Grippe 
(in  France). — An  epidemic  disorder  attended  with  great  depression, 
chilliness,  running  from  ej'es  and  nose,  frontal  headache,  cough,  rest- 
lessness, and  fever. — Probably'  due  to  some  peculiar  condition  or  con- 
tamination of  atmosphere. 

Symptoms.  Shivering  or  sense  of  chilliness  down  the  back,  followed 
by  heat  and  dryness  of  skin.  Urgent  frontal  headache  ;  aching  pains 
about  eyes.  Corj'za  and  sneezing.  Tenderness  of  fauces.  Hoarseness. 
Harassing  cough,  and  shortness  of  breath.  Pains  in  back  and  limbs. 
Perverted  taste,  with  disordered  stomach.  In  addition,  all  the  signs  of 
nervous  and  muscular  prostration.  Occasionally,  acute  bronchitis,  or 
pneumonia.  Euns  its  course  in  less  than  a  week :  often  ends  in 
diarrhoea,  or  diuresis,  or  profuse  sweating. 

Treatment.  Eest  in  bed  for  first  three  days,  in  properly  ventilated 
room.  Barley  water.  Cold  infusion  of  linseed,  lemonade,  soda  water, 
raspberry  vinegar,  &.C.  Tea  and  milk.  Mutton  or  chicken  broths.  In 
mild  cases,  drugs  unnecessary. — If  catarrhal  symptoms  are  urgent :  Ipecac- 
uanha and  conium.  Henbane.  Ethereal  tincture  of  lobelia.  Powder 
of  ipecacuan  and  opium  (gr.  10  at  night).  Indian  sarsaparilla  with  infu- 
sion of  linseed,  243.  Spirit  of  nitrous  ether  with  cam})horated  tincture 
of  opium,  348.  Inhalation  of  simple  vapors.  Iodine,  lime-water,  bella- 
donna, or  conium  spray,  262.  Sinapisms  to  chest.  Vapor,  or  hot  air, 
bath. —  When  prostration  is  a  prominent  symptom  :  Ammonia  and  bark, 
371.  Extract  of  beef,  L  AVine,  or  brandy.  Brand}- and  egg  mixture, 
17. — During  convalescence  :  Bark  and  phosphoric  acid,  370.  Quinine  and 
iron,  880.  Cod-liver  oil.  Nourishing  diet :  substitution  of  milk  for  tea 
and  coff'ee.     A  few  days'  holiday  in  the  country. 

INSANITY. — From  In,  neg.  j  sanus,  reasonable.  Synon.  Mental 
Alienatiuu ;  Unsound  Mind;  Deranged,  Intellect;  Madness. — No  useful 
definition  of  insanity  can  be  given.  Speaking  roughl}^,  it  may  be  said, — 
That  it  is  a  general  term  used  to  ex])ress  the  mental  condition  opj)osed 
to  sanity  ;  sanity  being  that  state  of  mind  which  enables  a  man  to  dis- 
charge his  duties  to  his  God,  his  neighbor,  and  himself 

Warnings.  Indications  of  impending  cerebral  mischief  often  to  be 
detected  by  physicians  some  months  before  they  attract  notice  of 
patient  or  his  i'riends.     Cerebral  att'ections   not  developed   suddenly ; 


INSANITY.  153 

often  rendered  incurable  by  neglect  of  treatment  in  earlj^  stages. 
Threatenings  "which  should  excite  alarm  are:  Headache,  severe  and 
frequent;  attacks  of  giddiness  and  mental  confusion;  paroxysms  of 
irritability,  and  loss  of  temper  without  sutficient  cause;  iiia])titude  for 
usual  occupations;  weariness  of  life ;  sleeplessness  or  lethargy  ;  loss  of 
memory;  some  marked  deviation  from  usual  line  of  conduct;  sanguin- 
eous tumors  about  external  ear;  defective  articulation;  dimness  of 
sight;  flightiness  of  manner;  sufferer  feels  that  he  is  not  quite  right, 
but  does  not  like  to  consult  a  physician.  He  shuns  his  old  friends;  is 
tortured  with  blasphemous  or  obscene  thoughts;  has  frightful  dreams; 
frequently  sutfers  from  dyspepsia. 

Complications.  Mental  diseases  often  accompanied  with  symptoms 
of  a  variety  of  bodily  disorders.  Of  all  forms  of  insanity  those  compli- 
cated with  general  paralj^sis,  or  with  epilepsy,  are  the  most  terrible. 

Insanity  with  general  paralysis  :  An  affection  sui  generis.  Sometimes 
spoken  of  as  "general  paralysis;"  "general  paresis;"  or,  more  appro- 
priately^, as  "  progressive  paral3'sis  of  the  insane." — Paralytic  lunatics 
seldom  live  more  than  from  one  to  three  years. — The  paralysis  may 
come  on  in  any  vari'ety  of  mental  disease,  increasing  as  power  of  mind 
diminishes.  The  tirst  indication  is  usually  an  impediment  to  movements 
of  tongue:  convulsive  trembling  of  lips:  articulation  muffled  and 
imperfect.  As  this  impediment  increases,  there  come  on  tottering, 
uncei'tain,  and  vacillating  movements  in  walking:  sometimes,  impair- 
ment of  locomotion  precedes  other  symptoms.  Handwriting  gets 
changed.  A  heavy  vacant  look.  Intelligence  and  judgment  greatly 
lessened.  Fits  of  irritability,  hallucinations,  and  illusions.  Loss  of 
memory.  Debasement  of  moral  character.  Pulse  gets  frequent  and 
feeble.  Tongue  on  being  protruded  curves  tremulously  from  side  to 
side.  Pupils  often  of  unusual  size,  and  their  mobility  lessened.  Excre- 
tions escape  involuntarily,  either  from  want  of  attention,  or  from  paraly- 
sis of  sphincters.  Ilemiplegic  seizures,  attended^vith  convulsions  orcoma, 
not  uncommon;  though  they  generally  pass  otf  after  use  of  stimulating 
enemata,  and  removal  of  any  collection  of  hardened  faeces.  As  disease 
progresses,  patients  become  unable  to  articulate  a  single  word;  they 
continually  grind  their  teeth;  their  weakness  such  that  the}-  cannot 
walk  or  stand;  all  traces  of  intelligence  get  abolished;  they  remain 
motionless  and  insensible,  their  torpid  existence  being  reduced  to  a  kind 
of  slow  death. — All  that  can  be  done  with  remedies  is  to  give  sleep, 
relieve  painful  symptoms,  and  support  strength.  Henbane,  in  twenty- 
grain  doses,  may  be  useful.  Nourishing  diet.  "Warmth.  Cleanliness. 
Attention  to  bowels  and  bladder. 

Insanity  with  Epilepsy:  Always  incurable.  Conduct  of  insane  epilep- 
tics most  ferocious;  homicidal  or  suicidal.  Filthy  and  disgusting  in 
their  habits.  Eesidence  in  a  well-ordered  asylum  does  much  to  induce 
a  certain  amount  of  mental  tranquillity.  Good  diet,  and  daily  exercise, 
contribute  to  physical  improvement.  Bromide  of  potassium  is  said  to 
reduce  the  frequency  of  the  fits,  and  to  soothe  nervous  irritability.  If 
early  death  do  not  result,  disease  usually  subsides  into  incurable  de- 
mentia. 

Varieties.  Differences  between  various  forms  of  insanity  always 
imperfectly  marked.  Descriptions  in  books  extraordinarily  distinct, 
compared  with  medley  of  sj'mjjtoms  in  real  cases.  Various  forms  fre- 
quentlj^  run  into  each  other. 

(1)  Mania  (Mai^o/iat,  to  rage),  or  leaving  madness:  Characterized  by 
general  delirium.  Reasoning  faculty,  if  not  lost,  is  disturbed  and  con- 
fused. Ideas  abundant,  erroneous,  absurd,  wandering.  Manners,  vio- 
lent, excited,  mischievous. 


154  INSANITY. 

Earely  comes  on  suddenl}-,  though  it  does  so  more  frequent!}'  than 
other  varieties.  Premonitorj' s^'mptoms :  Neglect  of  famil}' and  busi- 
ness. Distrust  of  relatives.  Causeless  attacks  of  anger  and  despon- 
dency. Insomnia. — Disease  sets  in  with  general  delirium,  and  extreme 
fur}'.  Tendency  to  suicide.  Shouting,  howling,  laughing,  reciting.  &.C., 
for  hours  together:  angry,  furious,  destructive,  ceaseless  movements. 
Weakness,  exhaustion,  emaciation.  Want  of  sleep.  Aversion  to  food. 
Incontinence  of  urine. — Eecovery  preceded  by  sleep,  desire  for  food, 
with  a  gradual  cessation  of  agitation  and  delirium. 

(2)  Monomania  (^Movoq,  alone;  iLahoiiai.  to  be  furious. — irrationality  on 
one  subject  only),  or  -partial  insanity:  That  form  in  which  the  under- 
standing is  deranged  to  a  certain  degree,  or  is  under  the  influence  of 
some  one  particular  delusion.  Mind,  vigorous:  ideas  few,  erroneous, 
fixed,  not  under  control.  Manners,  in  accordance  with  predominant 
idea.  A  false  principle  seized  upon,  which  is  pursued  logically,  and 
from  which  legitimate  consequences  are  deduced.  Thus,  a  monomaniac 
insists  that  his  body  is  made  of  glass;  and  impressed  with  this  idea  he 
takes  care  to  avoid  rough  handling,  lest  he  should  be  broken.  Or,  in 
belief  that  he  is  a  divine  instrument  of  vengeance,  he  may  commit  mur- 
der. Aside  from  his  partial  delirium,  he  will  reason  and  act  like  other 
men  ;  so  that  the  insanity  is  often  difficult  of  detection. 

There  are  particular  forms  of  monomania  :  Melancholia  (^MiXa^,  black; 
•/(i/'Ti,  bile),  or  lypemania  (ilu/nj,  sadness;  ixa'Aa),  is  characterized  by  fear, 
moroseness,  and  great  despondency:  an  unwillingness  to  move,  talk,  or 
take  food,  &c. — In  autophomania  (AtJTo^ouoq,  a  self-murderer),  there  is  a 
desire  for  suicide;  to  effect  which,  melancholies  will  take  most  extra- 
ordinary steps. — In  androphomania  CAvip,  a  man  ;  ^ovbow,  to  kill),  there 
is  an  uncontrollable  tendency  to  murder. — Pyromania  {llvp,  fire),  is 
marked  by  a  propensity  to  set  buildings  on  fire. — An  irresistible  desire 
to  steal  is  known  as  kleptomania  (A/.i--aj,  to  steal). — In  erotomania 
CEfiwq,  love),  amatory  delusions  rule,  just  as  religious  delusions  pre- 
dominate in  theomania  (6'£()?,  God),  or  religious  melancholy.  Erotomania 
may  be  an  excessive  degree  of  a  chaste  and  honorable  affection;  or  it 
may  be  combined  with  iiymjjhomania  (i\'o/i<frj,  the  nympha)  in  women, 
or  with  satyriasis  (^Id-upoq,  a  satyr)  in  men.  In  all  forms  of  erotomania 
there  is  great  mental  and  bodily  depression  ;  women  suffer  most  fre- 
quently, especially  the  single;  and  the  phenomena  are  often  connected 
with  some  disease  of  sexual  organs. 

(3)  Dementia  (De,  priv. ;  7nens.  the  mind),  or  incoherence:  That  condi- 
tion in  Avhich  weakness  of  intellect,  induced  by  accident  or  age,  is  the 
prominent  feature.  Mind,  altogether  feeble;  ideas  confused,  vague, 
wandering;  memory  much  impaired.  Patients  ignorant  of  time,  place, 
quantity,  property.  &c.;  forget  immediately  what  they  have  just  seen 
or  heard.  Manners  undecided,  childish,  and  silly.  The  demented  have 
neither  affections  nor  aversions,  nor  care  for  anything.  Paroxyms  of 
restlessness  and  excitement.  Little  or  no  control  over  bladder  and 
rectum.     In  last  stage,  complete  paralysi.s. 

(4)  Idiocy  (Idiota,  a  simpleton) :  Characterized  by  partial  or  com- 
plete absence  of  intellect,  owing  to  congenital  imperfection  of  brain. 
Mind,  not  developed  :  ideas,  simple  or  few.  Manners  foolish;  transient 
gusts  of  passion.  Countenance  vacant.  Sanguineous  tumors  about  ex- 
ternal ear.  Articulation  and  gait  often  imperfect.  Occasionally  the 
idiot  is  a  blind  deaf-mute. 

Treatment.  Prophylactic :  Eest  of  mind,  or  change  of  occupation  : 
proper  amount  of  sleep.  Attention  to  functions  of  sexual  system,  skin, 
liver,  kidneys,  alimentary  canal.  Removal  of  any  bodily  disorder. — 
Henbane.    Stramonium.     Indian  hemj).    Digitalis.    Morphia,  or  opium. 


INTERCOSTAL   NEURALGIA — INTERMITTENT    FEVER    OR    AGUE.        155 

Chloroform.  Quinine  and  steel.  Syrup  of  phosphate  of  iron.  Phosphate 
of  zinc  Bark.  Cod-liver  oil.  Nourishing  food  :  milk:  stimulants  with 
discretion.     Change  of  air  and  scene. 

Curative:  All  antiphlogistic  remedies  badly  borne.  Eemoval  of  other 
disorders, — skin  diseases,  uterine  disturbances,  syphilitic  taints,  gastric 
and  intestinal  disturbances,  &c.  Then,  in  ordinary  forms  of  insanity, 
a  nutritious  diet;  warm  clothing;  outdoor  occupations  and  amuse- 
ments ;  cheerful  recreation.  Sleep  at  night  to  be  procured  by  sedatives. 
Healthy  evacuations  to  be  obtained  from  bowels  by  vegetable  altera- 
tives, and  mild  aperients.  General  strength  to  be  improved  by  tonics. 
All  bad  habits,  as  onanisn^,  to  be  prevented.  Gentle  and  slow  attempts 
to  revive  affections,  and  strengthen  bewildered  intellect.  Baths  often 
useful, — douche,  shower,  warm,  or  Turkish.  Where  food  is  refused,  aiiy 
derangement  of  stomach  or  bowels  to  be  removed,  and  healthy  evacua- 
tions procured  :  this  failing,  forced  alimentation,  with  stomach  pump, 
will  be  required.  All  harshness  and  mechanical  restraint  to  be  avoided. 
Unfortunate  patient's  confidence  to  be  obtained;  every  promise  that  is 
made  must  be  kept ;  as  much  indulgence  as  possible  to  be  allowed. 

Restraint  in  a  well-managed  asylum,  often  necessary  to  enable  treat- 
ment to  be  effectually  carried  out :  imperatively  called  for,  when  patient 
has  suicidal  or  homicidal  tendencies. 

INTERCOSTAL  NEURALGIA.— Neuralgia  {Nehpov,  a  nerve;  akyo':^ 
pain)  may  affect  the  intercostal,  as  it  does  the  other  nerves  of  body. 
Chlorotic  and  hysterical  women  most  liable  to  it.  Sometimes  occurs 
in  Bright's  disease,  phthisis,  &c.  Must  not  be  confounded  with  neuritis, 
or  with  pleurisy. 

Symptoms.  Pain  of  a  dull  and  continued  aching  character,  or  sharp 
and  paroxysmal.  Sometimes  lasts  for  weeks.  Most  frequently  located 
in  sixth,  seventh,  eighth,  or  ninth  nerves  of  left  side.  Follows  course 
of  nerves  (anterior  primary  branches  of  dorsal),  extending  from  ante- 
rior part  of  thoracic  wall  directly  backwards  to  vertebi'se.  One  or  two 
painful  spots  sometimes  detected  on  pressure.  Occasionally,  cutaneous 
hypersesthesia  of  whole  mammar}'  or  infra-matumar}''  region.  Debilit3\ 
No  febrile  symptoms.  In  women,  catamenia  may  be  irregular;  leucor- 
rhoea. 

Treatment.  Quinine  and  aconite,  379.  Quinine  and  steel,  380. 
Steel  and  arsenic,  399.  Cod-liver  oil.  Belladonna  and  aconite  lini- 
ment, 281.  Strips  of  belladonna  plaster  completel}'  round  thorax. 
Flannel  bandage.  Subcutaneous  injection  of  morphia  or  atropine,  if 
there  are  one  or  more  sensitive  spots,  314.  Nourishing  food.  Malt 
liquors  or  wine. 

INTERMITTENT  FEVER  OR  AGUE.— From  Intermitto,  to  give  over 
for  a  time.  Synon.  Periodic  Fever.  Sometimes  termed  Paludal  fever, 
from  Palus,  a  fen  or  marsh. — See  Ague. — A  disease  chiefly  due  to 
marshy  miasms,  in  which  febrile  phenomena  occur  in  paroxysms,  are 
ushered  in  by  rigors,  and  end  in  a  critical  sweat.  During  the  remis- 
sion there  is  good  health  ;  but  at  end  of  a  definite  interval  the  phe- 
nomena are  repeated,  and  this  happens  again  and  again  until  a  cure  is 
effected. 

Three  species  of  intermittent  fever  or  ague,  viz.,  Quotidian,  Tertian, 
and  Quartan.  Tertian  most  common  in  this  country;  quotidian  in 
India.  When  the  paroxysm  occurs  at  same  hour  every  day,  it  is  called 
quotidian  ague  ;  when  every  other  day,  tertian,  though  secundan  would 
be  more  appropriate;  and  when  absent  for  two  whole  days,  and  then 
recurrent,  quartan.     In  first  species  the  interval  is  twenty-four  hours; 


156  INTESTINAL    CONCRETIONS — INTESTINAL    OBSTRUCTION. 

in  second,  fort3'-eight;  in  third,  seventy-two.  The  time  between  com- 
mencement of  one  parox3'sm  and  beginning  of  next  is  termed  the  in- 
terval; that  between  termination  of  one  paroxysm  and  commencement 
of  next,  the  intermission.  In  quotidians  the  paroxysm  occurs,  for  most 
part,  in  morning;  in  tertians,  at  noon  ;  in  quartans,  in  afternoon.  The 
tirst  is  most  common  in  spring;  the  second,  in  spring  and  autumn  ;  the 
third,  in  autumn. 

Symptoms.  An  ague  fit  is  composed  of  three  stages, — the  cold,  hot, 
and  sweating.  The  first  has  a  duration  varying  from  30  minutes  to  3 
or  4  hours  :  the  second  rarely  lasts  less  than  3  or  more  than  12  hours: 
while  the  third  continues  a  few  hours,  and  ends  in  complete  relief. 
Patient  comparatively  well  dui'ing  interval. — Enlargement  of  spleen,  a 
frequent  result — ague  cake.  Disturbance  of  liver  and  digestive  organs. 
Chronic  desquamative  nephritis  sometimes  a  consequence  of  repeated 
attacks. 

Treatment.  General  rules :  Removal  from  malarious  district.  Nour- 
ishing diet  with  stimulants.  Aperients,  or  emetics,  if  bowels  or  stomach 
be  loaded.  Bicarbonate  of  soda  or  potash,  with  a  few  drops  of  tincture 
of  belladonna,  if  bladder  be  irritable. 

In  cold  stage:  Warm  diluent  drinks,  as  weak  tea,  Avhite  wine  whey, 
or  negus.  External  warmth  by  blankets,  hot  bottles  to  feet,  hot  air 
baths. 

In  hot  .stage  :  Cooling  drinks.  Sponging  with  tepid  or  cold  water. 
Light  coverings.     In  sweating  stage :  Diluents  freely.    Eepose. 

Curative  remedies  :  Quinine;  2  or  3  grains  to  be  given  every  six  or 
eight  hours  during  the  intermission,  in  acid  infusion  of  roses.  In  Indian 
intermittents,  10  or  20  or  30  grains  of  quinine  during  sweating  stage. 
Subcutaneous  injection  of  quinine,  379.  Arsenic,  52.  Salicin.  Sulphate 
of  bebei'ia. 

To  reduce  the  spleen  :  Quinine  and  iron,  380.  Bromide  of  potassium, 
42.  Cod-liver  oil.  Friction  with  ointment  of  red  iodide  of  mercury 
diluted  with  an  equal  quantity  of  lard  Iodide  of  potassium  ointment. 
Compound  ointment  of  iodine. 

INTESTINAL  CONCRETIONS.— Synon.  Alvine  Calculi;  Intestinal 
Calculi. — Calculous  conci'ctions  ver}'  rare  in  human  intestines,  compared 
with  their  frequency  in  large  ruminating  animals.  In  man,  they  are 
more  common  in  ca?cum  and  colon,  than  in  other  portions  of  alimentary 
canal.  Bezoars  consist  chiefly  of  imperfectly  crystallized  earthy  salts 
and  indigestible  fibrous  matters,  arranged  in  concentric  layers  round  a 
nucleus — a  gall-stone  or  an}-  foreign  bod}'.  Other  concretions  may  con- 
sist solel}'  of  hardened  faeces,  with  the  phosphates  of  lime  and  magnesia  ; 
or  of  chalk  or  carbonate  of  magnesia,  where  these  substances  have  been 
largely  taken;  or  of  hair,  cotton,  or  paper  when  a  depraved  appetite 
has  led  to  the  consumption  of  either;  or  of  gall-stones  with  layers  of 
inspissated  mucus  and  ftecal  matter.  Either  kind  may  gradually  in- 
crease in  size,  until  there  is  complete  obstruction  of  the  gut.  In  for- 
tunate cases,  concretions  have  been  expelled  by  vomiting  or  passed  at 
stool.  When  situated  in  the  rectum,  they  can  be  removed  by  the  scoop. 
If  one  or  more  can  be  felt  through  the  abdominal  parietes,  producing 
obstruction,  an  incision  into  intestine  has  been  recommended,  all  other 
plans  failing. 

INTESTINAL  OBSTRUCTION.— Synon.  Ileus  (from  EtXim,  to  twist  or 

contract);  lleac  Passion;  Colique  de  Jlisericorde ;  Volvulus  {Volvo,  to 
turn  or  roll  itself  round  about). 


INTESTINAL    PERFORATION.  157 

Causes.  Excluding  examples  of  inguinal  and  femoral  and  umbilical 
hernia,  the  causes  are : 

(1)  Intermural,  or  those  originating  in  and  implicating  mucous  and 
muscular  coats  of  intestinal  walls : 

a.  Cancerous    stricture,  most   common   in  sigmoid  flexure  of 

colon  and  in  rectum. 

b.  Non-cancerous  stricture,  comprising — 

1.  Contractions  of  cicatrices  followino;  ulceration. 

2.  Contractions  of  walls  of  intestine  from  inflammation, 

non-cancerous  deposit,  or  injury. 

c.  Intussusception :    ileum   and   caecum   most    commonly  jjro- 

truded  into  colon. 

d.  Intussusception  associated  with  polypi. 

(2)  Extramural,  or  those  causes  acting  from  without,  or  affecting  the 
serous  covering : 

a.  Bands  and  adhesions  from  effusion  of  lymph, 

b.  Twists  or  displacements. 

c.  Diverticula. 

d.  External  tumors  or  abscesses. 

e.  Mesocolic  and  mesenteric  hernia. 

/.  Diaphragmatic  and  foramen  of  Winslow  hernia. 

g.  Omental  hernia. 

h.  Obturator  and  ischiatic  and  perineal  hernia. 

(3)  Intramural,  or  obstructions  produced  by  lodgment  of  foreign  sub- 
stances. 

a.  Foreign    bodies,    hardened    faeces,    concretions    having   for 
nuclei  gall-stones,  &c. 

Symptoms.  Constant  vomiting:  at  first  of  mucus  and  contents  of 
stomach,  but  in  a  few  days  of  fjecal  matter  (stercoraceous  vomiting). 
Pain,  often  very  severe.  Tympanites,  with  violent  borborygmi,  unless 
occlusion  be  high  up.  Hiccough,  especially  in  strangulation  of  upper 
part  of  small  intestines.  Mental  depression.  Pathognomonic  symptom 
— constipation.  Palpation  often  detects  increased  fulness  just  above 
obstruction  :  more  marked  diminution  of  resonance  at  this  point  than 
elsewhere.  Early  prostration.  Acute  peritonitis  commonly  occurs  in 
a  few  days.  Gangrene  most  frequent  in  intussusception  and  obturator 
hernia.  The  lower  the  obstruction,  the  less  urgent  the  vomitir)g,  and 
the  longer  the  time  before  it  commences.  The  higher  the  obstruction, 
the  greater  the  diminution  in  the  quantity  of  urine. 

Treatment.  When  diagnosis  is  doubtful :  Castor  oil.  Castor  oil  and 
turpentine  enema,  190.     Croton  oil  enema,  191. 

Directly  it  is  certain  a  mechanical  obstruction  exists:  Purgatives  injui'i- 
ous.  Extract  of  opium  (gr.  I  every  four,  six,  or  eight  hours).  Opium 
and  belladonna,  344.  Subcutaneous  injection  of  atropine,  314. — Fomen- 
tations. Linseed  poultices,  with  application  of  belladonna  and  opium, 
297. — Food  and  fluids  in  very  small  quantity.  Ice.  Frozen  milk.  Lime- 
water  and  milk,  14.  Tea  and  cream.  Brandy  and  water.  Essence  of 
beef,  3.  Eggs,  cream,  and  extract  of  beef,  5.  Brandy  and  egg  mixture, 
17. — Hot  baths.  Euemata  of  large  quantities  of  fluid,  with  manipulation 
of  intestines  by  pressure  on  them  through  abdominal  walls.  Gas- 
trotomy. 

INTESTINAL  PERFORATION.— The  intestine  may  be  perforated 
owing  to:  (1)  Disease  in  coats  of  bowel, — as  in  typhoid  fever,  inflam- 
mation of  csecum,  dysentery',  cancer  of  stomach  or  intestines,  &c.     (2) 


158  INTESTINAL    WORMS INTRA-THORACIC    TUMORS. 

From  extension  of  ulceration  in  disease  of  adjacent  organs, — as  in  hy- 
datids and  abscess  of  liver,  calculi  in  gall-bladder,  ovarian  tumors, 
extra-uterine  pregnancy,  ovarian  abscess,  pelvic  cellulitis,  cancer  of 
uterus  or  vagina,  and  suppuration  in  abdominal  parietes. 

INTESTINAL  WORMS.— Seven  principal  entozoa  (^Evrbz,  within; 
ifa)((i/,  ail  animal)  may  be  found  inhabiting  intestinal  canal :  Tricocephalus 
di.spar,  or  long  thread-worm  ;  Ascaris  luiabricoides,  or  large  round-worm  ; 
Oxyarls  vermlcularis,  or  small  thread-worm;  Sderostoma  duodenale,  un- 
known in  this  country;  Taenia  solium,  or  common  tape-worm;  Tamia 
wiediocanellata,  or  bookless  tape-worm  ;  and  Bothriocephalus  latiis,  or 
broad  tape-worm,  almost  peculiar  to  inhabitants  of  Switzerland,  Eussia, 
and  Poland. 

Symptoms.  Colicky  pains  and  swelling  of  abdomen.  Picking  of  nose. 
Itching  of  rectum  and  fundament.  Foulness  of  bi'eath.  Irregularity 
of  bowels.  Grinding  of  teeth  at  night.  Frequent  feeling  of  malaise. 
Voracious  or  impaired  appetite.  Only  conclusive  sign, — passage  of 
worms,  or  of  joints  of  them,  in  stools. — From  reflex  irritation,  ejiileptic 
attacks  or  chorea  may  occur. 

Treatment.  For  round  and  tape-worms:  Liquid  extract  of  fern  root, 
187.  Santonin,  185.  Oil  of  turpentine,  183.  Kousso,  184.  Kamela,  182. 
Calomel,  with  scammony  or  jalap,  159.  Garlic  (Allium  sativum).  Oil 
of  rue.  Assatoetida.  Oxide  of  silver.  Spigelia.  Decoction  of  pome- 
granate root.  Veratria.  Chloride  of  tin.  Sulphur.  Gamboge.  Croton 
oil.     Cowhage  (Mucuna  pruriens).     Common  salt. 

Fur  thread-worms:  Enemata  of  cold  water;  lime-Avater;  infusion  of 
quassia;  steel  and  quassia,  192;  common  salt,  188:  spirit  of  ether  (min. 
XV  to  each  ounce  of  water);  olive  oil.  Calomel  with  scammony,  or 
jalap,  159.     Santonin,  185. 

To  prevent  recurrence:  Avoidance  of  raw  and  underdone  animal  food, 
especially  pork  ;  as  well  as  of  imjjerfectly  washed  raw  vegetables.  Steel 
and  sulphate  of  soda,  180.  Quinine,  rhubarb,  and  hop,  370.  Infusions 
of  chamomile,  chiretta,  quassia,  or  rhubarb.  Quinine  and  steel,  380. 
Steel,  glycerine,  and  quassia,  392.  Compound  iron  mixture  and  aloes, 
393.  Extract  of  nux  vomica,  175.  Phosphate  of  iron,  405.  Steel, 
hydrochloric  acid  and  quassia,  397.  Ammonia  iron-alum,  IIG.  Glycerine. 
Cod-liver  oil.  Extract  of  wormwood  (Artemesia  absinthium).  Oil  of 
stinkweed  (Chenopodium  anthelniinticum). — See  Entozoa. 

INTRA-THORACIC  TUMORS.— May  be  aneurismal ;  or  composed  of 
cancer,  simple  exudation  matter,  fibrous  tissue,  or  of  fatty  or  steatoma- 
tous  matter.  Discarding  aneurisms,  these  tumors  have  their  origin  in 
the  glandular  structures,  and  are  developed  in  the  mediastina. 

Symptoms.  Chiefly  due  to  pressure  exerted  oti  heart  or  lungs,  or  on 
the  nerves  and  vessels.  Hence,  tumor  often  considei*able  before  it  in- 
terferes with  circulation  or  respiration. 

General  symptoms :  More  or  less  pain  ;  restlessness ;  cough  ;  dyspnoea, 
or  even  orthopnoea;  frothy  or  viscid  expectoration;  palpitation;  hoarse- 
ness; frequently  dysphagia;  sometimes  hemoptysis.  Pleuris}-,  bron- 
chitis, pneumonia,  laryngitis,  or  tracheitis  may  arise  from  constant  irri- 
tation. Pulmonary  collapse  may  be  caused  by  pressure.  Bulging,  or 
even  pei'foration,  of  ribs  and  sternum.  Di-splacement  of  heart.  Im- 
pediment to  circulation  through  aorta,  or  through  superior  or  inferior 
vena  cava  Dulness  on  percussion  more  marked  as  growth  protrudes 
into  anterior  mediastinum.  Auscultatory  signs  vary  according  to  nature 
of  secondary  complications. 

In  primary  cancer  involving  root  of  lung,  inflammatory  condensation 


INTUSSUSCEPTION — IRITIS.  159 

, of  pulmonary  tissue,  with  disorganization  and  abscess,  may  result  early. 
These  changes  probably  due  to  tumor  involving  and  destroying  all  or  a 
greater  part  of  pulmonary  nerves  as  they  pass  oif  from  root  of  lung. 

Death  takes  place  slowly  in  mediastinal  tumor  generally.  The  pain, 
want  of  sleep,  loss  of  appetite,  dyspnoea,  &c.,  weaken  patient.  Anaemia, 
followed  by  anasarca,  sets  in.  Sometimes  sudden  death  from  hemor- 
rhage, thrombosis,  or  spasm  of  glottis. 

Treatment.  All  that  can  be  done  is  to  palliate  symptoms.  Tem- 
porary relief  may  be  given  by, — Diuretics  and  aperients.  Antispas- 
modics,— Ether,  chloroform,  belladonna,  aconite,  stramonium,  opium, 
&e.  Iodide  of  potassium,  31.  Iodide  of  ammonium,  38.  Chlorate  of 
potash,  61.  Dry  cupping.  Inunction  with  red  iodide  of  mercury  oint- 
ment, 302.  Iodine  and  cod-liver  oil  ointment,  308.  Iodide  of  cadmium 
ointment,  311.  Yenesection  to  six  or  eight  ounces,  if  symptoms  of  pul- 
monary or  cardiac  congestion  predominate. 

INTUSSUSCEPTION.— From  Intus,  within ;  suscipio,  to  carry.  Synon. 
Invagination  i^In,  witlii)i;  vagina,  a  sheath). — That  condition  in  which 
one  part  of  the  bowel  is  drawn  into  another  portion,  just  as  the  finger 
of  a  glove  is  pulled  within  itself  Owing  to  the  congestion,  effusion, 
and  inflammation  which  result,  the  canal  of  the  bowel  gets  more  or  less 
obstructed. 

The  intussusception  maybe  single  or  multiple:  the  traction  is  usually 
from  above  downwards:  in  about  half  the  cases,  ileum  and  cfficum  pro- 
truded into  colon  :  most  common  in  young  children  and  aged  persons. 

Sy.mptoms.  The  chief  are  sudden  violent  pain;  sickness;  obstinate 
constipation;  discharges  of  blood  and  mucus  peranum.  Spontaneous 
reduction  may  take  place.  In  less  fortunate  cases,  inflammation  of  peri- 
toneal coats  of  involved  portion  usually  sets  in  between  third  and 
seventh  days  ;  opposed  surfaces  becoming  adherent.  Inflammatory  ac- 
tion may  end  in  gangrene;  several  inches  of  included  sjihacelated  bowel 
coming  away  by  stool,  and  leaving  canal  of  gut  free. 

Treatment.     See  Intestinal  Obstruction. 

IRITIS. — From  '^fptt;,  the  rainbow, — any  object  supposed  to  resemble 
a  rainbow;  terminal  -itis.  Synon.  Jriditis ;  Inflanimatio  Iridis. — Sus- 
pended (like  a  curtain  with  a  circular  aperture  in  its  centre)  between 
the  cornea  and  crystalline  lens,  and  bathed  on  both  sides  by  aqueous 
humor,  the  iris  serves  to  regulate  amount  of  light  admitted  to  retina. 
By  it,  the  cavity  containing  aqueous  humor  is  divided  into  an  anterior 
and  a  posterior  chamber. — Iris  composed  of  delicate  bundles  of  fibrous 
tissue,  of  circular  and  radiating  involuntary  muscular  fibres,  and  of 
pigment  cells.  Sometimes,  absent;  or  only  present  in  a  rudimentary 
form,  a  condition  known  as  Irideremia. — In  Albinism  the  iris  is  of  a  rose 
color,  while  pupils  present  a  deep  red  appearance  owing  to  absence  of 
opaque  pigment  (uvea). — In  Coloboma  the  two  halves  of  the  iris  have 
failed  to  unite,  in  consequence  of  arrest  of  development,  so  that  jmpil 
has  an  elongated  form. 

1.  Acute  Inflammation. — -The  iris  is  seldom  alone  attacked  ;  sclerotic 
and  deep-seated  textures  of  eye  generally  also  involved.  Hence,  ob- 
jections have  been  raised  to  use  of  term  Iritis:  its  employment  "has 
the  effect  of  dii*ecting  the  practitioner's  attention  to  the  iris,  which 
bears  a  great  deal  of  inflammation  without  destruction  to  the  organ, 
and  withdrawing  it  from  the  retina,  which  bears  very  little  without 
permanent  injury  to  vision."  (Jacob.) 

Symptoms.     In  first  stage,  ii-is  presents  a  confused  appearance,  owing 


160  IRITIS. 

to  its  fibrous  texture  becoming  indistinct :  loses  its  contractile  power, 
and  undergoes  a  change  in  color.  Sclerotic  becomes  extra-vascular.  In 
next  stage,  fibrine  effused  on  surface  of  iris,  and  in  anterior  chamber.  If 
inflammation  proceed,  pupil  may  get  closed,  or  its  margin  become  ad- 
herent to  capsule  of  lens;  or  cornea  may  be  rendered  opaque;  or  per- 
manent opacity  of  lens  or  its  capsule  may  result. 

The  important  symptoms  may  be  thus  enumerated  :  (1)  Zonular 
sclerotitis;  fine  hair-like  vessels,  running  in  radii  towards  edge  of 
cornea.  (2)  Discoloration  of  iris.  If  naturally  blue,  it  becomes  green- 
ish ;  if  dark  colored,  reddish.  This  the  result  of  increased  vascularity, 
or  of  eff'usion  of  lymph  into  its  substance,  or  on  its  posterior  surface. 
(3)  Contraction,  irregularity^,  and  immobility  of  pupil.  (4)  Etfusion  of 
coagulable  lymph  into  pupil  and  posterior  chamber,  and  occasionally 
into  anterior  chamber.  (5)  Adhesions  of  iris,  and  especially  of  pupil- 
lary edge,  to  capsule  of  lens;  in  some  rare  cases,  to  cornea.  (6)  Tuber- 
cles, pustules,  or  small  abscesses  of  iris.  (7)  Dimness  of  sight,  and 
sometimes  total  blindness.  (8)  Pain  in  eye,  and  nocturnal  circumor- 
bital  pain.  (Mackenzie.) 

Not  to  be  supposed  that  in  every  case  all  the  foregoing  symptoms  will 
be  met  with  :  rather  a  certain  number  of  them  will  be  found,  sufficient 
to  render  diagnosis  certain.  Constitutional  disturbance  well  marked, 
though  not  generally  severe. 

If  inflammation  be  not  checked,  it  creeps  on,  involves  choroid  coat 
and  retina,  and,  spoiling  delicate  texture  of  latter,  completely  destroys 
sight  forever.  When  one  eye  has  been  permanently  injured  from  any 
cause,  sympathetic  subacute  inflammation  is  not  unfrequently  set  up  in 
the  sound  organ  at  the  end  of  some  months,  or  even  in  the  course  of  a 
few  days,  which  may  go  on  to  produce  complete  destruction.  To 
prevent  this  it  is  often  necessary  to  remove  the  eye  which  was  first 
damaged. 

The  chief  causes  are:  Exposure  to  cold  and  wet,  giving  rise  to  rheu- 
matic or  idiopathic  iritis;  syphilis,  causing  syphilitic  iritis;  injuries 
and  wounds  producing  traumatic  iritis;  and  certain  conditions  of  the 
constitution,  especially  the  scrofulous,  rheumatic,  and  gouty. 

Iritis  arising  as  a  secondary  eftect  of  syphilis,  is  perhaps  the  most 
common.  May  occur  at  all  ages.  Usually  attended  with  other  eftects 
of  constitutional  syphilis — copper-colored  eruptions,  nodes,  pains  in 
bones  especially  severe  at  night,  and  ulceration  of  thrOat.  At  first, 
redness  is  less  severe  than  in  rheumatic  form;  there  is  seldom  any 
haziness  of  cornea,  as  in  rheumatic  iritis;  iris  often  assumes  a  rusty 
color,  especially  near  pupillary  edge;  pu])il  is  apt  to  be  displaced,  and 
to  be  drawn  upwards  towards  the  root  of  the  nose. 

Treatment.  Mercury,  bleeding,  and  belladonna  are  the  supports  on 
which  practitioner  has  been  taught  to  rely.  That  the  first  tAVO  agents 
may  be  advantageously  dispensed  with  is  pi'oved  by  rejiorts  of  sixty- 
four  cases;  all  of  which  were  cured  by  sustaining  general  health,  re- 
lieving jjain  with  narcotics,  and  keeping  pupil  dilated  by  belladonna 
(Dr.  W.  H.  Williams). 

The  object  must  be  to  check  flow  of  blood  towards  the  part ;  to  arrest 
eff'usion  of  fibrine;  and  to  procure  absorption  of  that  poured  out  To 
gain  these  ends,  patient  to  be  kej^t  quiet,  preferably  in  darkened  room, 
and  with  eye  protected  from  light.  Sedative  foinentations,  if  the  eye 
is  morbidly  sensitive;  bowels  to  be  kept  regular  by  mercurial  purga- 
tives, or  enemata;  opium  to  be  given  to  relieve  pain:  diet  to  be  plain 
but  nourishing,  and  free  from  stimulants.  Iodide  of  potassium  (81) 
often  of  great  value,  especially  in  rheumatic  and  strumous  iritis:  in 
that  dependent  upon   syphilis,  mercurj^  (25,  34,  131)  sometimes  more 


JAUNDICE.  161 

useful,  though  not  to  salivation. — If  there  he  depression, — Ammonia  and 
bark,  371:  quinine,  379;  salicin  and  sarsaparilla,  388. —  When  circumor- 
bital  pain  is  intense, — relief  may  be  alforded  by  mixing  three  grains  of 
powdered  opium  with  ten  of  mercurial  ointment,  and  well  rubbing  the 
compound  into  the  temple. —  The  pupil  to  be  kept  Jildted  (in  order  to  pre- 
vent iris  from  forming  adhesions  with  capsule  of  crystalline  lens)  by 
belladonna;  or  more  conveniently  by  solution  of  atropine,  288;  or  by 
discs  of  gelatine  atropine  paper.  No  astringent  or  other  collyria  should 
be  employed. 

Other  remedies  recommended:  Turpentine;  colchicum  ;  cod-liver  oil; 
santonin  ;  henbane.  Stramonium  (locally,  as  a  substitute  for  bella- 
donna.) 

2.  Inflammation  of  Iris  and  Cornea. — It  was  erroneouslv  believed 
until  recently  that  a  serous  memhraiie  or  capsule  covered  the  posterior 
surface  of  cornea,  both  surfaces  of  iris,  and  front  of  capsule  of  lens. 
Hence,  the  present  disease  was  su])po8ed  to  consist  of  inflammation  of 
this  membrane,  and  was  named  "  aquo-capsulitis." 

Symptoms.  They  run  a  chronic  course.  There  is  chiefly, — intole- 
rance of  light;  vascularity  of  sclerotic;  haziness  of  cornea;  and  slight 
change  in  color  of  iris.  General  health  alwaj's  bad.  The  disease  very 
obstinate  in  delicate  children.  Probably  always  the  result  of  inherited 
syphilis. 

Treatment.  Mild  alteratives  ;  tonics;  good  diet.  Tincture  of  iodine 
carefully  applied  to  skin  of  ej^elids  often  relieves  intolerance  of  light. 

3.  Mydriasis. — From  Muddut,  to  be  damp ;  because  the  disease  was 
supposed  to  be  occasioned  by  redundancy  of  humors. — From  pai'alysis 
of  third  nerve  or  motor  oculi,  long  continued  use  of  belladonna,  and 
other  causes — the  iris  sometimes  loses  its  power,  so  that  pupil  remains 
dilated.  This  condition  must  not  be  confounded  with  immobilit}'  of 
pupil  owing  to  disease  of  retina,  from  which  it  may  be  distinguished 
by  a  simple  experiment  practised  hy  ophthalmic  surgeons.  The  patient 
is  directed  to  supply  the  want  of  a  contracted  iris  by  looking  through 
a  large  pin-hole  in  a  card  held  close  to  the  eye.  If  case  be  one  of 
mydriasis,  he  will  see  perfectly;  whereas,  if  retina  be  diseased,  the 
aperture  will  be  nearly  or  quite  useless. — The  remedies  for  mydriasis 
consist  of  tonics  which  act  specially  upon  the  nervous  sj^stem, — Zinc, 
414,  416  ;  nux  vomica,  387,  409.  Phosphate  of  iron,  405.  Strj'chnia  and 
steel,  408.  Ergot  of  rye.  A  succession  of  blisters  to  the  temple.  Con- 
cave glasses  often  serviceable.  Tlie  local  employment  of  the  Calabar 
bean  might  be  useful  where  the  disease  has  been  caused  by  belladonna. 

4.  Myosis. — From  Mbo),  to  contract.  An  unduly  contracted  state  of 
the  pupil. — There  is  obscurity  of  vision,  especially  in  a  weak  light.  The 
remedies  are  rest,  with  tonics  to  improve  the  general  health.  The  use 
of  belladonna  has  been  condemned. 

JAUNDICE. — Probably  from  the  Fi-ench  Jaunir,  to  become  yellow. 
Synon.  Icterus. — A  prominent  sj-mptom  of  many  varied  morbid  processes. 
Like  albuminuria,  glucosuria,  &c.,  a  symbol  of  changes  going  on  in  the 
economy,  rather  than  a  specific  disease. 

All  forms  can  be  included  under  one  of  two  divisions:  (1)  Those  due 
to  suppression  of  biliary  functions,  in  which  the  coloring  matter  of  biie 
and  cholesterine  accumulate  in  the  blood.  (2)  Those  arising  from  re- 
absorption  of  bile  properly  formed,  the  flow  of  which  into  duodenum  is 
impeded.  After  jaundice  from  obstruction  has  existed  some  time,  sup- 
pression likewise  occurs;  owing  to  backward  pressure  exerted  on  hepatic 

11 


162  KELOID — KNOCK-KNEES 

parenchj^ma  by  over-distended  bile-tubes  impeding  capillary  circulation 
through  the  gland. 

Symptoms.  Yellowness  of  conjunctivre  and  skin.  Saffron  hlie,  or 
brownish-black  tinge,  of  urine;  according  to  amount  of  bile-pigment 
present.  White  color,  or  light  clay  appearance,  of  faeces.  Itching  of 
skin.  Perhaps,  exhaustion;  drowsiness,  giddiness,  and  peevishness; 
bitter  taste ;  slow  pulse;  dyspepsia,  especially  for  fatty  food.  Exception- 
ally, corne^e,  or  aqueous  and  vitreous  humors  have  become  jaundiced; 
making  all  objects  appear  of  yellow  hue. 

If  disorder  be  of  long-continuance,  there  may  be  marked  stupor, 
delirium,  and  other  indications  of  cerebral  derangement.  Weakness 
and  emaciation  from  malnutrition.  Tendency  to  hemorrhage — bleed- 
ing from  gums,  purpura,  etc. — Where  there  is  obstruction  from  a  gall- 
stone, most  severe  suffering  results;  vomiting  and  hiccup;  perhaps 
fatal  exhaustion. 

In  jaundice  from  srippressio7i  urine  only  contains  those  biliary  ingre- 
dients which  exist  preformed  in  the  blood.  In  that  from  obstruction, 
besides  these,  there  are  materials  (bile-acids)  generated  in  liver  itself; 
which  have  been  reabsorbed  into  circulation  from  overcharged  gall- 
bladder and  ducts.  To  distinguish  between  these,  add  gently  to  about 
two  fluid  drachms  of  urine  half  a  drachm  of  strong  sulphuric  acid,  and 
a  piece  of  loaf  sugar  as  large  as  a  j^ea.  If  at  line  of  contact  of  the  two 
liquids  a  purple  or  scarlet  color  is  pi'oduced,  it  shows  that  acids  of  bile 
are  present, — jaundice  therefore  due  to  obstruction  :  if  merely  a  brown- 
ing of  the  sugar  takes  place,  there  are  probably  no  bile-acids,  and  the  case 
is  one  of  suppi*ession.  (Harley). 

Treatment.  From  suppression :  Sulphate  of  soda  and  taraxacum,  144. 
Nitric  acid,  senna,  and  taraxacum,  147,  227.  Eesin  of  podophyllum,  30, 
160.  Benzoic  acid,  479.  Colchicum,  46.  ISTitro-hydrochloric  acid,  378. 
Hydi'ochlorate  of  ammonia,  60.  Acid  tartrate  of  potash  drink,  356. 
Sulphate  of  manganese,  172. 

From  obstruction  :  Compound  decoction  of  aloes.  Pill  of  Barbadoes 
aloes.  Sulphate  and  carbonate  of  magnesia,  141.  Squills,  digitalis  and 
broom,  219.  In  long-continued  obstruction,  capsules  of  pig's  bile,  170. — 
See  Gall-Stones. 

KELOID. — Perhaps  from  KrjXr,.  a  tumor;  el(5o?,  like.  Described  by 
Alibert,  as  Kelis.  Cheloidea,  or  Cancroide;  owing  to  its  presenting  a 
flatfish  raised  patch  of  integument,  resembling  the  shell  of  a  tortoise 
(^XiXu<;,  a  tortoise,  terminal  -ides.) — Consists  of  flat  tender  excrescences 
or  cuticular  folds;  one  or  more  inches  in  diameter;  7-aised  a  few  lines 
above  level  of  skin  ;  having  irregular  forms  Avith  slight  depressions  in 
their  centres;  and  covered  with  wa'inkled  eijidermis.  Sometimes,  ex- 
crescence resembles  a  cicatrix  left  by  a  burn.  There  may  be  only  one 
tumor,  or  several.  Disease  developed  slowl}' ;  rarely  ends  in  ulceration ; 
sometimes  disappears  spontaneously,  merely  leaving  a  cicatrix;  is 
usually  found  on  chest  between  the  manimre;  and  is  verj^  uncommon. 

Treatment.  Arsenic,  52.  Donovan's  triple  solution,  51.  Iodide  of 
potassium.  Cod-liver  oil.  Eemoval  by  knife,  or  caustics,  injurious. 
Pressure,  useless. 

KNOCK-KNEES. — Synon.  Genua  Valga. — A  relaxation  of  internal 
lateral  ligaments  of  knee-joints,  allowing  femur  and  tibia  to  become  sep- 
arated, so  that  an  angular  obliquity  of  the  bones  results. — May  come  on 
in  delicate  and  strumous  children  when  the}-  begin  to  walk.  Not 
uncommon  in  porters  who  carry  heavy  weights  on  the  head.     When 


LARYNGISMUS    STRIDULUS — LARYNGITIS.  163 

treatment  is  called  for  may  be  remedied  by  an  articulated  apparatus 
extending  from  pelvis  to  beel.     Improvement  of  general  health. 

LARYNGISMUS  STRIDULUS.— From  Aapv'rfi%u>,  to  vociferate  with 

all  liis  might:  Htridco.  to  make  a  hissing  noise.  Synon.  Apncea  Infan- 
tum; Jjaryngospasmus ;  Infantile  Laryngismus ;  Thymic  Asthma;  Spuri- 
ous or  Cerebral  Croup  ;  Child-crowing. — A  spasmodic  disease  occurring  in 
infants,  chiefly  during  dentition.  It  consists  of  a  temporary,  partial,  or 
complete  closure  of  rima  glottidis ;  by  which  entrance  of  air  into  lungs 
is  impeded  or  stopped. 

Symptoms.  Interruption  of  breathing.  Eigidity  of  fingers  and  toes, — 
carpo-pedal  spasm.  Child  suddenly  seized  with  dyspnoea  :  it  struggles 
and  kicks,  is  unable  to  inspire,  and  seems  about  to  be  suffocated. 
Presently,  spasm  ceases ;  air  drawn  through  chink  of  glottis  with  a 
shrill  whistling  or  crowing  sound.  Paroxysms  may  return  in  a  few 
hours  or  days. 

Treatment.  During  paroxysm:  Hot  water  to  lower  parts  of  body, 
with  cold  affusion  to  head  and  face.  Slapping  of  chest  and  nates, 
sharply.  Exposure  of  face  and  chest  to  current  of  cold  air.  Gentle  in- 
halation of  chloroform.  Vapor  of  ether  or  ammonia  to  nostrils.  Arti- 
ficial respiration,  drawing  tongue  well  forwards.  As  a  last  resource, 
tracheotomy. — During  interval:  Mild  purgatives.  Anthelmintics,  if 
necessary.  Antispasmodic  tonics  :  Zinc  and  belladonna.  92.  Assa- 
foetida.  Hydrocyanic  acid.  Valerianate  of  iron.  Quinine.  Cod-liver  oiL 
Especially  change  of  air.  Cold  sea- water  sponge  baths.  Simple  diet, 
with  milk.     Lancing  of  gums,  if  they  be  tender  and  swollen. 

LARYNGITIS. — From  Adpuy^,  the  windpipe;  terminal  -itis. — Acute 
inflammation  of  the  larynx  is  a  rare  disease;  it  is  generally  fatal. 
CEdema  of  glottis  may  occur  from  other  causes  than  acute  inflammation. 
Larynx  also  liable  to  chronic  inflammation,  ulceration,  polypi,  kc. 

1.  Acute  Laryngitis. — Synon.  Inflammatio  Laryngis;  Cynanche  Laryn- 
gea ;  Angina  Laryngea. — Almost  peculiar  to  adults.  Generally  arises 
from  cold  and  wet  in  unhealthy  constitutions.  Ocasionally  caused  by 
syphilis.  Inflammation  often  of  limited  exteut :  the  great  danger  due 
to  its  situation. 

Symptoms.  Come  on  insidiously.  At  end  of  some  hours, — fever; 
redness  of  fauces;  pain  referred  to  pomum  Adami ;  difficulty  of  breath- 
ing and  swallowing ;  considerable  anxiety;  hoarseness  or  even  com- 
plete loss  of  voice.  Spasmodic  exacerbations  :  paroxysms  of  threatened 
suffocation.  Long  inspirations:  peculiar  wheezing  sound,  as  if  air  were 
drawn  through  a  narrow  tube.  Perhaps,  harsh  and  brassy  cough. 
Dysphagia:  liquids  swallowed  Avith  more  difficulty  than  solids.  Face 
gets  flushed;  eyes  protruded;  pulse  hard;  great  general  distress. 
Larynx  and  trachea  move  rapidly  upwards  and  downwards:  all 
the  muscles  of  respiration  brought  into  strong  action,  so  that  chest 
heaves  violentl}?".  Patient  gasps  for  breath :  tries  perhaps  to  get  to 
open  window.  He  soon  sinks  into  a  drowsy  and  delirious  state;  and 
speedily  dies  suffocated,  from  obstruction  of  chink  of  rima  glottidis. 

Treatment.  Eest  and  quiet :  forbid  talking.  Air  of  room  to  be  kept 
moist:  temperature  70°  F.  Turpentine,  or  hot  water,  stupes  to  neck. 
Extract  of  belladonna  to  neck,  with  linseed  poultices.  Inhalation  of 
steam  of  boiling  water;  or  of  vapor  medicated  with  hydrocyanic  acid 
or  a  little  chloroform,  261.  Inhalation  of  spray  medicated  Avith  stramo- 
nium, belladonna,  conium,  or  iodine,  262.  A  respirator  to  be  Avorn  dur- 
ing intervals  betAveen  inhalations.     Directh'  there  are  indications  that 


164:  LEAD    COLIC — LEPRA. 

the  blood  is  not  thoroughly  oxygenated, — tracheotomy.    Milk,  or  cream. 
Raw  eggs.     Beef  tea.     Wine  or  brandy. 

Bleeding,  blistering,  calomel,  tartarated  antimony, — positively  inju- 
rious. If  disease  be  due  to  constitutional  syphilis, — free  mercurial 
inunction  5  mercurial  vapor  baths,  131. 

2.  (Edema  of  Glottis. — Synon.  (Edematous  Laryvgitis;  Hydrops  Glot- 
tidis;  Submucous  Ldryngitis. — May  be  caused  b}'  larj-ngitis  ;  boiling  water, 
or  corrosive  poisons  taken  accidentally  into  mouth;  poison  of  erysip- 
elas. Sometimes  simulated  by  d^'spnoea  of  general  anasarca,  renal  dis- 
ease, &c.  Hence  a  laryngoscopic  examination  should  often  be  made  to 
remove  all  doubt.  To  favor  subsidence  of  tumefaction  sponge  epiglottis 
and  cavity  of  larynx  with  solution  of  nitrate  of  silver  (gr.  60  of  crystals 
to  one  ounce  of  distilled  water).  Scarifications  of  oedematous  swelling 
may  be  successfully  made  b}^  aid  of  laryngoscope.  These  plans  failing, 
— laryngotomy  or  tracheotomj'. 

3.  Chronic  Laryngitis,  &c. — Chronic  inflammation  and  ulceration  not 
uneouiuiun  in  pulniunar}'  consumption  :  a  species  of  tuberculosis  known 
as  phthisis  laryngea, — Membrane  lining  laryngeal  cartilages  often  be- 
comes thickened  and  ulcerated  in  constitutional  syphilis. — Polj'pi  and 
warty  tumors  arise  from  different  parts  of  larj^nx  :  cause  great  impedi- 
ment to  entrance  and  exit  of  air.  May  be  removed  by  aid  of  laryngo- 
scope with  a  small  wire  ecraseur. — Epithelial  cancer  occasionally  seated 
about  vocal  cords. — See  Foreign  Bodies  in  Air-passages. 

LEAD  COLIC. — S3'non.  Painter's  Colic;  Saturnine  Colic;  Morbus  3Ie- 
taliicus ;  Colica  Bachialgia ;  Dry  Gripes  or  Bellyache;  Colica  Pictonum^ 
from  its  former  frequenc}'  among  the  Pictoiies  or  inhabitants  of  Poictou. 
— Attacks  of  colic,  vomiting,  and  constipation  from  the  jDresence  of  lead 
in  the  s^'stem.     Often  followed  by  paralysis. 

Symptoms.  In  addition  to  those  of  ordinary  colic,  an  intense  grind- 
ing or  twisting  sensation  round  navel:  retraction  of  abdominal  integu- 
ments towai'ds  spine  :  pain  in  back.  A  blue  or  slate-gray  line  round 
edges  of  gums. 

House  painters  suflFer  most  frequently:  often  have  manj^  attacks  be- 
fore muscles  of  arms  become  affected  with  paralysis,  causing  drop-wrist. 
Sleeping  in  a  recently  painted  room,  drinking  fluids  which  have  been 
kept  in  leaden  vessels,  taking  snuff  adulterated  with  lead,  &c.,  are  not 
uncommon  causes. 

Treatment.  During  attack:  Calomel  and  jalap,  with  sulphate  of 
magnesia,  140.  Sulphate  of  magnesia  and  sulphuric  acid,  1-42.  Sulphate 
of  soda  and  sulphuric  acid.  143.  Castor  oil,  1()4.  Croton  oil,  168.  Ene- 
mata  of  warm  water.  Hot  baths.  0})ium  and  chloroform,  316.  Morphia 
and  ether,  315.  Morphia,  chloroform,  and  Indian  hemp,  317.  Opium 
and  belladonna,  344.  Faradization:  perhaps  Avhile  patient  is  under 
influence  of  chloroform.  Farinaceous  food. — Subsequently,  to  eliminate 
poison:  Iodide  of  potassium,  31.  Sulphur  baths,  125.  Sulphate  and  car- 
bonate of  magnesia,  141.  Colchicum,46. — Prophylactic  :  Sulphuric  acid 
drink.  Attention  to  functions  of  skin  and  bowels.  Avoidance  of  abuse 
•of  alcoholic  drinks. — See  Colic;  Paralysis  (section  9). 

XEPRA. — From  /l^-/5a,  a  scal^'state  of  the  skin.  Synon.  Common  Dry 
Tetter;  IJurojiean  Leprosy;  Alphos ;  Psoriasis. — The  most  obstinate  and 
ti'oublesome  of  all  curable  cutaneous  diseases.  A  non-contagious  squa- 
mous eruption  ;  consisting  of  red  and  scaly  circular  patches,  of  various 
dimensions,  scattered  over  different  parts  of  body.  Most  frequently 
found  in  the  neighborhood  of  the  joints,  especially  near  the  knee  and 


LEUCOCYTHEMIA LICHEN.  165 

elbow.  By  degrees,  pateheH  increase  in  size  and  number,  and  extend 
along  extremities  to  trunk. 

Varieties.  When  the  patches  are  of  moderate  size,  round  and  red- 
dish, and  covered  with,  tliin  white  scales,  affection  known  as  lepra 
vulgaris:  when  eruption  is  smaller  and  whiter  than  the  foregoing,  and 
of  long  standing,  disease  termed  lepra  alphoides :  when  it  is  copper- 
colored,  result  of  syphilis,  syphilifie  lepra. 

Treatment.  Locally:  Warm  baths.  Alkaline  baths,  121.  Tar  oint- 
ment (unguentum  picis  liquidffi,  Phar.  Lond.  1851). 

Internally :  Aloes,  gentian,  and  potash,  148.  Pepsine  and  aloes,  155. 
Nitric  acid,  senna,  and  taraxacum,  I-IT.  Ammonia  and  rhubarb,  IGl. 
Arsenic,  52.  Donovan's  triple  solution,  51.  Sarsaparilla  and  corrosive 
sublimate,  27.  Infusion  of  dulcamara.  Tar  capsules,  36.  Tincture  of 
cantharides.  226.  Cod-liver  oil.  Sulphur.  Colchicum.  Iodide  of  potas- 
sium, HI.  Eed  iodide  of  mercury,  54.  Ked  iodide  of  mercury  and  ar- 
senic, 55.  Harrogate  waters,  466.  Purton  spa,  462.  Bareges,  470.  Simple 
nourishing  food:  avoidance  of  stimulants. 

LEUCOCYTHEMIA.— From  Aeuxdq,  white;  xurac;,  a  cell;  and  al/m, 
blood.  i6ynon.  Leucocytosis ;  Leucaemia;  White  Cell  Blood. — A  morbid 
state  of  the  blood,  in  which  the  white  corpuscles  are  greatly  increased 
in  numbei",  while  the  red  cells  are  much  diminished.  Connected  with 
hypertrophy  of  one  or  more  of  the  lymphatic  glands,  or  of  the  spleen. 

Symptoms.  Anajmic  pallor.  Emaciation  and  debility.  Abdominal 
swelling.  Disordered  respiration.  Loss  of  appetite.  Mental  depres- 
sion. Diarrhoea.  Nausea.  Hemorrhage  from  nose,  lungs,  or  stomach. 
Jaundice.     Anasai'ca.     Ascites.     Prostration,  ending  in  death. 

Treatment.  Bark,  22,  376.  Iron,  21,  392,  394,  405.  Quinine,  379, 
380.  Carbonate  of  ammonia.  Cod-liver  oil,  389.  Gallic  acid,  103. 
Alkaline  hypophosphites,  419.  Iodide  of  potassium.  Chloride  of  potas- 
sium. Nourishing  food.  Pepsine,  420.  Stimulants.  Sea  air.  Chalyb- 
eate mineral  waters. 

LEUCODERMA. — From  Asuxd:;,  white ;  diprm,  the  skin.  Synon.  Leii- 
eopathia;  Chloasma  Album;  Alphosis ;  Achroma. — A  rare  condition;  in 
which  the  skin  is  rendered  white  in  various  sized  patches,  from  loss  of 
cutaneous  pigment.  Occurs  especially  in  negroes, — "  the  piebald  negro." 
General  health  not  affected. 

LEUCORRHCEA.— From  Asuxo^,  white;  ^'a>,  to  flow.  Synon.  Menstrua 
Alba;  Fluor  Aluliebris ;  Catarrhus  Genitalium;  The  Whites. — A  mucous 
discharge  from  the  lining  membrane  of  the  uterine  cavity,  or  of  the 
vaginal  canal.  Hence,  there  may  be  uterine  or  vaginal  leucorrhoea. — 
See  Endometritis  ;  Vaginitis. 

LICHEN. — From  Aeiyr,'^,  moss.  Synon.  Papxdce  Siccoi ;  Licheniasis 
Adultorwm;  Lichenovs  Bash. — An  obstinate  and  annoying  papular  affec- 
tion of  the  skin.  Recognized  by  the  minute,  hard,  red  elevations  which 
it  presents,  and  which  are  either  distinct  or  ari-anged  in  clusters;  by 
the  tingling  and  irritation;  and  by  the  slight  desquamation  which  fol- 
lows. 

Varieties.  (1)  Lichen  simplex:  Eruption  of  red  inflamed  papuhie,  on 
face  or  arms,  extending  to  trunk  and  legs.  Slight  fever;  itching  or 
tingling;  eruption  fades  in  about  a  week,  when  desquamation  takes 
place.  Disease  apt  to  return  every  spring  or  summer  in  irritable  con- 
stitutions. Sometimes  mistaken  for  measles  or  scarlet  fever. — (2)  Lichen 
pilaris,  or  hair  lichen:  a  modification  of  preceding;  papula?  appear  only 


166  LIP^MIA — LUMBAR,    PSOAS,    AND    ILIAC    ABSCESS. 

at  roots  of  hairs.  Often  due  to  stomach  derangement,  especially  that 
from  abuse  of  alcoholic  drinks. — (3)  Lichen  circumscriptus,  or  clustered 
lichen:  jjatches  of  papulae,  with  well-defined  margins  and  an  irregularly 
circular  form. — (4)  Lichen  agrius,  or  wild  lichen:  most  severe  form; 
ushered  in  by  fever.  Papulae  much  inflamed  ;  developed  on  an  erj'them- 
atous  surface,  which  appeal's  hot  and  painfully  distended.  In  a  short 
time,  inflammation  diminishes:  papulae  become  covered  with  furfuraeeous 
desquamation ;  or  their  points  are  scratched  off,  surrounding  skin  be- 
comes fissured  into  deep  painful  cracks,  and  sero-purulent  fluid  exudes, 
forming  thin  scaly  crusts.  Itching,  tingling,  and  smarting  intense; 
fever,  nausea,  headache,  rigors,  and  other  s^^mptoms  of  constitutional 
disturbance.  In  mild  cases,  symptoms  may  subside  and  eruption  die 
away  in  fourteen  days  :  in  severe  varieties,  disease  frequently  prolonged 
for  months. — (5)  Lichen  lividus:  distinguished  by  livid  hue  of  papulae, 
which  chiefly  form  on  limbs,  and  are  not  accompanied  b}^  fever. — (6) 
Lichen  tropicus,  or  prickly  heat :  peculiar  to  tropical  climates.  Appears 
to  be  partly  due  to  exposure  during  heat  of  day,  before  system  has  be- 
come acclimatized. — (7)  Lichen  urticatus,  or  nettle  lichen  :  peculiar,  inas- 
much as  its  commencement  is  marked  by  occurrence  of  wheals,  like 
those  produced  by  bites  of  bugs  or  gnats.  "Wheals  subside  and  leave 
papulae,  which  are  sometimes  obstinate  ;  both  wheals  and  jiapula)  accom- 
panied with  itching,  pricking,  and  tingling. 

Treatment.  Fo?'  all  forms  except  Ath  and  5th  :  Only  simple  i-emedies 
required.  Tepid  baths  :  mild  laxatives  :  acidulous  drinks  :  an  unstimu- 
lating  diet.  Irritation  to  be  relieved  by  acetate  of  lead  and  hydrocyanic 
acid  lotions,  263 :  or  by  equal  parts  of  subacetate  of  lead  and  oxide  of 
zinc  ointments :  or  by  glycerine  and  water,  equal  portions :  or  by  cor- 
rosive sublimate  lotion,  271 :  or  b}'  collodium,  285. 

Lichen  Agrius:  Steel  and  aloes.  154.  Steel  and  sulphate  of  magnesia, 
166.  Pepsine  and  aloes,  155.  JSTitric  acid  and  bark,  376.  Arsenic,  52. 
Corrosive  sublimate, 27.  Turkish  bath,  130.  Mercurial  vapor  bath,  131. 
Sulphur  baths,  125.  Cod-liver  oil.  Iodine.  Iodide  of  jiotassium.  Col- 
chicum.     Pepsine. 

Lichen  Lividus:  Quinine  and  mineral  acids,  379.  Quinine  and  steel, 
380.  Phosphate  of  iron,  405.  Tincture  of  perchloride  of  iron  and  gly- 
cerine, 392.     Cod-liver  oil.    Generous  diet :  milk:  malt  liquors>or  wine. 

LIPJEMIA.  —  From  ih'-a,  fat;  aqm,  blood.  Fatty  blood. — See  Piar- 
hccniia. 

LOCKED-JAW. — Synon.  Trismus,  from  Tpt'Cw,  to  gnash  with  the  teeth. 

— See  Tetanus. 

LUMBAGO. — From  Lumbus,  the  loins.     Synon.  Bheumatismus  Dor- 

salis ;    liachirrheuma. — See  Chronic  Rheumatism. 

LUMBAR,  PSOAS,  AND  ILIAC  ABSCESS.  — Chronic  collections  of 
pus  in  these  situations  generally  due  to  caries  of  bodies  of  dorsal  ver- 
tebrae. More  seldom,  are  caused  by  general  debility  without  spinal  dis- 
ease.    Occur  especially  in  strumous  subjects. 

Symptoms.  Quantity  of  pus  usually  large.  When  it  points  in  the 
loins,  generally  on  one  side  of  spine,  it  is  known  as  lumbar  abscess. 
"When  in  the  groin,  below  Poupart's  ligament,  having  travelled  along 
the  course  of  one  or  both  psoae  muscles,  it  is  termed  psoas  abscess. 
When  above  Poupart's  ligament,  it  is  called  iliac  abscess.  In  excep- 
tional cases,  the  abscess  has  burst  into  peritoneum,  large  intestines,  or 
pleura.     "V^ery  rarely  the  pus  has  been  absorbed. 


LUPUS — MAMMARY   ABSCESS.  167 

Treatment.  When  a  permanent  cure  cannot  be  hoped  for,  it  is  un- 
wise to  interfere  unless  there  be  pain  or  much  inconvenience.  If  diag- 
nosis of  spinal  disease  be  uncertain,  or  if  there  be  ranch  pain  or  hectic 
fever,  or  if  the  abscess  appear  lilvely  to  burst,  its  contents  may  be  let 
out  by  a  valvular  incision  and  the  opening  closed.  Puncture  with  trocar 
and  canula  sometimes  advised.  In  all  cases,  improvement  of  general 
health  necessary.  Bark.  Ferruginous  tonics.  Good  diet.  Cod-liver 
oil.     Sea  air. 

LUPUS. — From  Lupus,  a  wolf, — owing  to  its  destructive  character. 
Synon.  Ulcus  Tuberculosum;  Noli  me  Tangere. — A  destructive  skin  dis- 
ease; commencing  in  the  form  of  one  or  more  indolent,  soft,  dull-red 
tubercles,  which  become  covered  with  scabs,  have  a  tendency  to  heal 
spontaneously,  and  always  leave  a  scar.  Most  common  on  the  face: 
occurs  in  the  young  or  middle-aged:  and  is  more  often  met  with  in 
women  than  men. 

Varieties.  Two  forms, — Lupus  non-exedens,  and  Lupus  exedens.  In 
the  first,  little  or  no  ulceration,  yet  the  tubercles  leave  deep  cicatrized 
pits  behind  them;  while  when  it  spreads  rapidly  and  superficially,  the 
skin  is  left  crossed  by  white  sear-like  ridges  and  bands.  The  second, 
very  destructive;  attacks  the  nose  more  frequently  than  any  other 
region  of  body.  Extent  of  parts  which  it  destroys  varies;  sometimes 
the  whole  nose  being  eaten  away,  sometimes  only  the  point. — Both 
varieties  maybe  present  in  same  case:  disease  on  alse  nasi  consisting  of 
lupus  exedens,  while  that  on  face  is  of  non-exedens  form.  Moreovei-, 
whether  ulceration  be  present  or  not,  the  disease  is  essentially  the  same. 

Treatment.  Litertially :  (Inin'me,  379.  Quinine  and  steel,  380.  Qui- 
nine, steel,  and  arsenic,  381.  Arsenic,  52.  Cod-liver  oil,  389.  Iodide 
of  iron  and  cod-liver  oil,  390.  Phosphate  of  iron,  405.  Opium.  Nour- 
ishing food.     Exercise  in  pure  air. 

Jjocally :  Free  destruction  of  entire  tubercle  or  ulcer  by  some  poten- 
tial caustic;  repeating  application  until  a  healthy  surface  results.  Chlo- 
ride of  zinc,  rubbed  in,  or  applied  in  paste,  197.  Potassa  fusa.  Arsenic 
and  calomel  powder,  203.  Acid  solution  of  nitrate  of  mercury,  195. 
Pure  carbolic  acid.     Chromic  acid,  196. 

MALACOSTEON.— From  MaXay.oq,  soft;  dffriov,  a  bone.  Synon.  Mol- 
litles  O.'isiuiii. — See  Osteomalacia. 

MALIGNANT  VESICLE. — Synon.  Charhon. — A  furunculoid  disease 
conveyed  from  cattle  to  man  by  inoculation. 

Symptoms.  A  pimple  or  vesicle,  which  usually  forms  on  a  surface 
habitually  exposed.  Swelling  and  discoloration.  Severe  carbuncular 
inflammation:  enormous  swelling:  brawny  hardness :  loss  of  vitality : 
blackness.  Fetid  breath.  Embarrassed  respiration.  Great  prostra- 
tion.    Death  with  symptoms  of  general  blood  poisoning. 

Treatment.  Early  incisions.  Extirpation.  Scarifications,  with  ap- 
plication of  caustics.  Potassa  fusa.  Acid  solution  of  nitrate  of  mer- 
cuiy.     Actual  cautery. 

Sulphite  of  soda  or  magnesia,  48.  Bark.  Quinine.  Opium.  Tar 
capsules,  36.  Essence  of  beef,  2,  3.  Cream  or  milk.  Haw  eggs.  Alco- 
holic stimulants.     Current  of  pure  air  over  bed. 

MAMMARY  ABSCESS.— Synon.  Mastodynia  Apostematosa ;  Milk  Ab- 
scess ;  Abscess  of  the  Breast. — May  be  acute  or  chronic :  the  former  a  re- 
sult of  active  inflammation.  Forms  either  in  substance  of  gland,  or 
between  gland  and  skin,  or  between  gland  and  chest  walls. 


168  MAMMARY    HYPERTROPHY — MAMMARY   TUMORS. 

Symptoms.  Acute:  Occurrence  of  rigors  during  progress  of  inflam- 
mation. Engorgement  of  breast.  Deep-seated  or  diffused  burning 
pains:  thi'obbing,  and  sense  of  heavy  weight.  Formation  of  a  painful 
point.  Fhictuation.  Symptoms,  general  and  local,  most  severe  in  intra- 
glandular  abscess. 

Chronic  :  Most  important,  because  the  lump  or  knot  in  breast  is  apt  to 
be  mistaken  for  a  malignant  tumor.  Matter  forms  very  slowl}^ :  may 
be  result  of  scrofula  or  derangement  of  general  health,  without  any  in- 
flammatory symptoms.  Occurs  in  puerperal  and  in  sterile  Avomen. 
First  indications,  are  hardness  of  gland  and  soreness  about  nipple.  An 
imperfectly  circumscribed  and  uneven  tumor  can  be  detected:  fluctua- 
tion indistinct,  often  difficult  to  appreciate,  owing  to  thickness  of  plastic 
effusion  round  the  jnirulent  collection.  Nipple  ma}^  be  retracted.  Ad- 
hesion occurs  between  tumor  and  skin. 

Treatment.  Tonics  and  stimulants.  Nourishing  food  :  malt  liquors. 
Introduction  of  grooved  needle,  if  diagnosis  be  doubtful.  Free  punc- 
ture at  most  depending  point.  Drainage  tube.  Poultices.  Pressure 
with  long  strips  of  sti-apping.  Care  necessary  to  prevent  sinuses  from 
burrowing.  If  they  form,  pressure  or  stimulating  injections  can  be 
tried ;  or  setons  should  be  passed  through  them.  Attention  to  digestive 
and  uterine  organs. 

MAMMARY  HYPEETROPHY.— Enormous  hypertrophy  of  one  or 
both  breasts  may  occur  in  single  and  married  women.  Usually  one 
gland  first  begins  to  enlarge,  and  slowl}^  increases  in  size.  At  the  end 
of  a  year  or  more,  opjiosite  mamma  gets  affected.  No  inflammatory 
s5'mptom8,  induration,  or  pain.  Enlai'gement  becomes  burdensome,  and 
unsightly.  Affected  gland  may  project  firmly  from  thorax ;  or  it  may 
hang  flabby  and  loose — pendulous  breast.  In  many  cases,  the  uterine 
functions  are  imperfectl}^  performed.  General  health  usually  impaired. 
Occasionally,  perhaps,  the  result  of  masturbation.  The  worst  case 
which  the  author  has  seen,  w^as  attributed  to  imperfect  sexual  inter- 
course :  both  breasts  were  affected,  reaching  to  the  umbilicus. 

Treatment.  Very  unsatisfjictory.  Improvement  of  general  health. 
Attention  to  uterine  functions.  Pressure  with  strips  of  ammoniac  and 
mercur}^,  or  mercurial,  or  litharge,  or  belladonna  plaster;  or  by  spring 
pads,  or  Dr.  Arnott's  air  cushion.  Where  patient  is  pregnant,  a  hope 
of  cure  may  be  entertained  when  lactation  is  set  up.  Various  prepara- 
tions of  iodine  have  been  largely  tried :  seldom  with  any  benefit.  The 
clitoris  has  been  excised.  In  very  severe  cases,  one  or  both  breasts 
have  been  amputated. 

MAMMARY  TUMORS.— The  female  breast  may  be  the  seat  of  several 
varieties  of  tumor.  Some  are  simple;  and  with  one  or  two  exceptions, 
are  composed  of  elements  more  or  less  resembling  those  entering  into 
the  structure  of  the  normal  gland.  Others  are  malignant ;  and  are 
formed  of  elements  foreign  to  the  healthy  organism. 

1.  Lacteal  Tumor. — From  Lac,  milk.  Synon.  Galactocele  (Fr/Ja,  milk ; 
xyj/.Tj,  a  tumor);  Lactocele ;  Milk  Tumor. — A  distension  of  one  or  more 
lacteal  tubes,  owing  to  occlusion  of  the  oi'ifices;  or  a  rupture  of  a  milk 
duct,  with  escape  of  contents  into  surrounding  connective  tissue. 
Occurs  during  lactation. 

Symptoms.  A  cystic  growth,  varying  in  size  from  that  of  a  walnut 
to  that  of  an  orange,  can  be  felt;  which  when  recent  is  elastic  and  fluc- 
tuating. As  the  serous  portion  of  the  milk  gets  absorbed,  the  tumor 
becomes   firmer   and   feels    almost   solid.     Absence  of  pain.     General 


MAMMARY    TUMORS.  169 

lienlth  unaffected.  Enlargement  commonly  discovered  by  accident  : 
patient  alarmed,  fearing  cancer.  Very  rarely  the  earthy  salts  of  the 
milk  form  a  small  concretion, — lacteal  calculus. 

Treatment.  Free  puncture,  keeping  the  wound  pervious  until  all 
discharge  ceases.  Sometimes  a  cure  cannot  be  effected  until  gland 
tissue  becomes  inactive, — until  infant  is  weaned.  If  slight  inflamma- 
tion and  suppuration  follow  the  puncture,  tbere  will  be  no  need  for 
anxiety :  a  cure  will  occur  as  in  abscess. 

2.  Fatty  Tumor. — Masses  of  fat  may  be  developed  within  the  breast, 
or  in  front  or  behind  it.  They  give  rise  to  an  appearance  of  mammary 
hypertroph}^.  Such  tumors  grow  slowly,  sometimes  attain  a  weight  of 
several  pounds,  and  are  only  inconvenient  from  their  bulk. 

3.  Enchondromatous  and  Osteoid  Growths. — Cartilaginous  and  bony 
tumors  have  been  found  in  the  breast  on  a  very  few  occasions. 

4.  Fibro-Plastic  Growths. — Synon.  Recurrent  Fibrous  Tumor. — O^very 
rare  occurrence.  The  tumor  may  attain  a  large  size  :  the  integuments 
ulcerate,  giving  exit  to  a  fungating  mass  which  often  bleeds  readily. 
The  lymphatics  are  not  involved.  Cleneral  health  good.  After  removal 
there  is  great  probability  of  a  recurrence  of  the  disease, — perhaps  on 
five  or  six  or  more  occasions. 

5.  Hydatid  Cysts. — Cysts  containing  entozoa  have  been  found  in  the 
breast.  Echinococci  to  be  detected  on  a  minute  examination  of  the 
fluid  contents  of  the  sacs.  Sometimes  curable  by  puncture  of  parent 
C3^st,  and  compression  ;  or  by  withdrawal  of  parent  cyst  through  a  free 
incision.     Occasionally  extirpation  must  be  resorted  to. 

6.  Chronic  Mammary  Tumor.  —  Synon.  Adenoid  Tumor;  Adenocele 
CAdr^v^a  gland;  xrj atj.  ii  tumor);  Pajicreatic  Sarcoma;  Partial  Hypertro- 
phy; Mammary  Glandidar  Tumor;  Hydatid  Disease  of  Breast;  Sero- 
cystic  Sarcoma. — A  tumor  of  the  breast,  which  generally  commences  in 
healthy  women  between  the  time  of  puberty  and  the  thirtieth  year: 
single,  more  liable  than  married  women.  Growth  slow  :  an  enormous 
size  may  ultimately  be  obtained.  Sometimes  remains  stationary  for  a 
long  time,  and  then  rapidly  increases  in  bulk  ;  sometimes  gradually 
diminishes,  perhaps  owing  to  absorption  of  fluid  contents  of  cysts. 
Never  disappears  entirely.  May  be  due  to  mechanical  injury.  One 
variety  of  mammary  tumor  is  dense,  compact,  lobulated,  and  provided 
with  a  fibrous  capsule  :  ducts  and  sinuses  are  developed  through  the 
new  growth.  In  another  form,  there  are  cj^sts  with  growths  attached 
to  their  walls,  and  floating  in  fluid.  In  a  third  group,  dilated  ducts 
get  converted  into  cysts,  with  gi'owths  of  gland  tissues  springing  from 
their  sides. 

Symptoms.  The  tumor  begins  as  a  small,  movable,  nodulated  groAvth  : 
it  appears  isolated  from  gland  tissue ;  is  not  painful ;  does  not  involve 
skin  ;  no  enlargement  of  axillary  glands.  As  the  foreign  body  grows, 
the  true  breast  may  atrophy.  Eate  of  growth  very  variable.  When 
large,  the  integuments  may  ulcerate;  occasionally  tumor  protrudes 
through  ulceration  as  a  fungating  mass. 

Treatment.  Eemedies  to  induce  absorption  only  injure  the  general 
health.  When  the  growth  is  increasing,  excision  should  be  resorted  to. 
Heeurrence  is  rare. 

7.  Mucous  Cysts. — Consist  of  diluted  and  expanded  gland  ducts  filled 
with  mucus  and  epithelium.  There  may  be  one  or  several  cysts,  in  one 
or  l)oth  breasts.  The  growths  seldom  attain  a  greater  size  than  that  of 
a  filbert.     Most  common  after  childbearing  period  is  over.     A  cure  can 


170  MAMMILLARY   DISEASES^MAMMITIS. 

often  be  effected  by  puncture  and  pressure.     This  fiiiling,  and  irritation 
arising,  the  breast  will  have  to  be  amputated.  '' 

8.  Malig-nant  Tumors. — Cancer  of  the  breast  may  be  of  the  nature  of 
scirrhous,  medullar}',  or  colloid :  the  first  by  far  the  most  common. 
Alwaj-^s  primary.  Only  one  mamma  generally  affected.  Frequently 
developed  between  the  ages  of  forty  and  fifty.  The  tendency  of  the 
disease  is  to  increase,  to  ulcerate,  to  cause  great  pain,  to  affect  the 
lymphatics  and  glands,  to  diminish  health  and  flesh  and  strength,  to  set 
up  the  cancerous  cachexia,  to  lead  to  secondary  deposits  in  distant 
organs,  and  to  destroy  life  in  less  than  four  years  from  commencement. 

The  male  breast  occasionally  becomes  the  seat  of  malignant  disease. 
— See  Cancer. 

MAMMILLARY  DISEASES.  — The  nipple,  or  mammilla  (dim.  of 
Maiiiiiio.  the  breast),  may  he  tlie  seat  of  certain  morbid  processes. 

The  chief  are:  Chronic  eczema  and  psoriasis.  There  are  excoriations 
covered  with  rather  thick  crusts.  Aggi*avated  by  pressure  against 
stays.  May  usually  be  cured  by  lime  liniment,  zinc  ointment,  or  lotions 
of  sulphate  of  zinc.     In  obstinate  cases,  arsenic,  52. 

Inflammation  of  ni])ple  very  common  at  commencement  of  lactation. 
Exquisitely  painful  ulcers  or  abrasions  form, — "  fissures,"  "  chaps,"  or 
"  cracks."  The  acute  suffering  sometimes  impairs  general  health ; 
there  is  constant  dread,  mental  depression,  loss  of  appetite,  restless 
nights.  The  disease  may  often  be  prevented  by  bathing  nipple  night 
and  morning,  during  last  few  weeks  of  pregnane}^,  WMth  astringents, — 
Port  wine,  brandy,  or  saccharated  lime-water.  Numerous  curative 
measures  recommended ;  the  most  efficient  being, — CoUodium,  285. 
Solid  nitrate  of  silver,  but  it  causes  great  pain  on  first  application. 
Lead  or  zinc  lotions,  264.  Balsam  of  Peru  and  spermaceti  ointments, 
806.  Cxlycerine.  or  almond  oil.  Lime  liniment.  Borax  and  glycerine 
lotion,  268.  Dusting  with  powdered  spermaceti,  or  oxide  of  zinc,  tied 
up  in  a  muslin  bag.  Nipple  to  be  well  dried  after  nursing:  child  not  to 
be  allowed  to  lie  with  it  in  the  mouth,  after  a  proper  meal.  Nipple- 
shields,  of  glass  or  boxwood  or  vulcanized  India  rubber,  to  afford  pro- 
tection during  suckling.  Mucous  membrane  of  infiant's  mouth  to  be 
examined,  so  that  any  aphthous  or  other  morbid  state  may  be  rectified. 
Other  means  failing,  infant  to  be  nursed  only  from  sound  breast. 

Malignant  disease  ma}'  attack  either  the  male  or  female  nipple.  Early 
extirpation  is  the  only  remedy. 

MAMMITIS.  —  From  Mamma,  the  breast;  terminal  -itis.  Synon. 
Mazoitis ;  Mastitis;  Tnflammatio  Mammoi. — Inflammation  of  the  breast 
may  be  acute  or  chronic.  Generally  occurs  during  lactation  :  from 
cold;  irritation  of  sore  nipple;  external  injury j  too  poor  a  diet;  in- 
attention to  suckling  at  pi-opcr  intervals;  general  debility;  or  sym- 
pathy with  gastric,  intestinal,  hepatic,  uterine,  ovarian,  or  renal  irrita- 
tion. 

Symptoais.  When  acute:  Considerable  pain,  swelling,  induration. 
Shivering,  fever,  quick  pulse,  loaded  tongue,  delirium.  Secretion  of 
milk  soon  checked.     Suppuration  commonly  results. 

In  c/;ro?u'c  form:  Comes  on  insidiously.  Enlargement  of  gland  and 
induration  :  the  hardness  much  less  than  in  scirrhus.  Often  ends  in 
suppuration.  May  follow  acute  inflammation  ;  or  ma}'  arise  in  women 
of  strumous  constitution  quite  independently  of  childhearing. 

Treatment.  Acnte:  Antiphlogistic  remedies  not  advisable;  though 
rapid  cures  are  said  to  have  been  effected  by  saline  purgatives,  antimo- 


MASTODYNIA MEASLES.  171 

iiials  ami  leeches.  Mild  aperients.  Iodide  of  potassium,  31.  Aconite 
and  0])ium,  332.  Fomentations.  Hemlock  poultices.  Linseed  poulti- 
ces, with  application  of  extract  of  belladonna.  Three  or  tour  leeches, 
where  there  is  great  congestion  and  the  powers  of  life  are  not  enfeebled. 
The  breast  to  be  supported.  Arm  to  be  kept  quiet,  by  a  sling  or  ban- 
daging to  the  side.  Infant  to  be  weaned  at  commencement.  If  milk 
accumulates  and  causes  painful  distension,  it  must  be  drawn  otf  with 
breast-pump.  Incision,  as  soon  as  there  is  fluctuation.  Tonics,  and 
good  nourishing  food. — See  Mammary  Abscess. 

(7A/-o/i<c;  Ammonia  and  bark,  371.  Quinine  and  mineral  acids,  371. 
Cod-liver  oil.  Nourishing  food.  Support  and  pressure  by  strips  of 
strapping,  belladonna  plaster,  or  bandage.  Abscess  to  be  opened  at 
most  depending  point. 

MASTODYNIA. — From  Matrrd-:,  the  breast;  ddu'^vj,  pain.  Synon.  Mazo- 
dynia  ;  JLtstalgia  ;  Neuralgia  of  Mamma. — The  female  breast  is  not  un- 
frequentiy  the  seat  of  distressing  pains,  without  an}'  structural  disease 
of  the  gland. 

Symptoms.  Occasionally  there  is  slight  heat  and  more  or  less  swelling 
of  affected  breast.  Sometimes  the  lobules  feel  rather  firmer  than  is 
natural.  More  commonly  the  gland  is  healthy  to  the  touch.  The  pain 
may  be  of  a  weaiying,  aching  character  :  it  maybe  very  acute,  liable  to 
exacerbations,  and  perhaps  periodic, — like  neuralgia  elsewhere.  Yery 
frequently  due  to  some  ovarian  or  uterine  irritation.  In  many  women 
the  breasts  are  irritable  at  the  commencement  of  each  menstrual  period. 
General  health  seldom  good.  Nervous  temperament.  Loss  of  appetite, 
constipation,  restless  nights,  anxiety. 

Treatment.  Cure  of  the  disorder  on  which  the  pain  depends. 
Eemoval  of  any  ovarian  or  uterine  irritation.  Attention  to  diet,  exer- 
cise, clothing. 

Quinine,  379,  411.  Ammonia  and  bark,  371,  372.  Aconite,  330,  374. 
Quinine  and  belladonna.  383.  Cod-liver  oil.  Pepsine,  420,  Castor  oil. 
Iodide  of  lead  and  belladonna  in  vaginal  pessaries,  423.  Friction  of 
breasts  with  belladonna  liniments,  265,  281.  Support  by  strapping  or 
bandage,  if  breast  is  pendulous.  The  breast  has  been  amputated;  the 
pain  returning  in  cicatrix,  or  in  opposite  gland. 

Young  infants,  and  boys  or  girls  about  the  time  of  puberty,  are 
liable  to  enlargement  and  tenderness  of  breasts.  Sometimes  there  is 
secretion  of  milk.  The  disorder  subsides  spontaneously,  provided  irri- 
tation is  not  kept  up  by  application  of  iodine  and  similar  drugs.  The 
author  has  more  than  once  seen  abscess  in  breast  of  infant,  from  the 
nurse  using  friction  with  oil  "  to  rub  the  milk  away." 

MEASLES. — From  the  Saxon  MesaU,  or  2IyseJ,  leprous :  Meazel,  a 
leper  or  diseased  person.  Synon.  Morbilli ;  Rubeola. — A  continued 
infectious  fever,  preceded  by  catarrh,  accompanied  by  a  crimson  rash, 
and  often  attended  or  followed  by  inflammation  of  the  mucous  mem- 
brane of  the  oi'gans  of  respiration.  Some  authors  divide  measles  into 
two  grades, — the  morbilli  mitiores,  and  morbilli  graviores ;  but  the  latter 
only  differs  from  the  former  in  its  greater  severity,  and  in  the  fact  that 
the  eruption  assumes  a  dark  purple  color. 

Symptoms.  After  a  period  of  incubation  var3'ing  from  10  to  15  days, 
there  are  lassitude,  shivering,  pj-rexia,  and  catarrh  ;  the  conjunctivae, 
Schneiderian  membrane,  and  mucous  membrane  of  the  fauces,  larynx, 
trachea,  and  bronchi  being  much  affected.  Swelling  of  eyelids,  with 
eyes  suffused  and  watery,  and  intolerant  of  light ;  sneezing  ;  dry  cough, 
hoarseness,  and    severe   dyspnoea;    drowsiness;    great   heat   of  skin; 


172  MEDULLARY    CANCER MELANOSIS. 

tOijother  with  frequent  and  hard  pulse.  The  eruption  comes  out  on 
fourth  day  of  fever  and  fades  on  seventh  :  it  consists  of  dots  which 
coalesce  into  small  blotches,  raised  above  the  skin,  and  often  of  a  horse- 
shoe shape.  Fever  does  not  abate  on  appearance  of  eruption.  Pulmo- 
nsivy  complications  are  to  be  feared,  especially  in  winter  and  spring 
months.  Occasionally,  life  endangered  by  the  occurrence  of  larj-ngitis, 
cancrum  oris,  severe  otitis,  epistaxis,  acute  tuberculosis,  or  acute  des- 
quamative nephritis. 

Treatment.  Confinement  to  bed  in  a  moderately  warm  room.  Pedi- 
luvia.  Milk  diet ;  acid  or  mucilaginous  drinks.  Castor  oil.  Ehubarl)  and 
magnesia.  Cream  of  tartar.  Solution  of  acetate  of  ammonia.  Etfei'- 
vescing  saline  mixtures.  Spirit  of  nitrous  ether.  Carbonate  of  ammo- 
nia. Alcoholic  stimulants  if  there  be  depression.  Ipecacuanha  and 
morj^hia,  if  cough  be  troublesome.  Colchicum.  Sponging  with  vinegar 
and  water.  Inunction  with  oil  or  lard. — Bark;  quinine;  steel;  cod- 
liver  oil;  and  nourishing  food  during  convalescence. 

MEDULLARY  CANCER.— From  Medulla,  pith  or  marrow.  Synon. 
Enci'i>holoid  Cancer. — ' Kyy.itfaXu':,  the  brain. — These  cancers  are  of  two 
kinds — soft  and  tirm  ;  the  former  most  frequent.  In  either  condition 
they  are  found  as  separable  tumors,  or  as  infiltrations.  As  separable 
tumors,  when  occurring  in  testicle,  breast,  eye,  intermuscular  and  other 
spaces  in  limbs;  as  infiltrations,  when  occupying  the  substance  of  uterus, 
alimentarjT^  canal,  serous  membranes,  and  hones.  In  either  form  their 
course  towards  a  fatal  career  is  ra])id  :  average  duration  of  life,  from 
patient's  first  observation  of  disease,  little  more  than  two  years. — See 
Cancer. 

MELANOID  CANCER.— From  .IMaww,  to  grow  black.  Synon.  Car- 
cinoma Mehinoti.cinn  ;  Fungus  Jlelanodes;  Black  Cancer. — Consists  gen- 
erally of  medullary  cancer  modified  by  the  superaddition  of  black 
pigment.  Scirrhus  sometimes  becomes  associated  with  melanosis,  and 
more  rarely  epithelioma  does  so. — See  Cancer. 

MELANOSIS. — From  MiXaq,  black;  v6(r(><;,  disease.  Synon.  Nigritudo  ; 
Black  Tubercle. — A  rare  disorder,  characterized  by  the  deposition  in 
various  tissues  of  the  body,  of  a  black  or  dark-brown  substance. 

Melanotic  formations  may  take  place  in  various  parts  of  body, 
iTiay  present  much  variety  of  form,  and  may  owe  their  production  to 
difltei-ent  agents.  They  are  divided  into  two  great  groups  (Carswell)  : 
(1)  True  Melanosis,  of  which  there  is  only  one  kind.  (2)  Si^urious 
Melanosis,  of  which  there  are  three  kinds — a,  that  arising  from  the  in- 
troduction of  carbonaceous  matter  ;  b,  from  the  action  of  chemical  agents 
on  the  blood  ;  and  c,  from  the  stagnation  of  the  blood. 

1.  True  Melanosis. — Has  its  seat  most  commonly  in  connective  and 
adipose  tissues  ;  but  it  is  also  found,  though  rarely,  in  mucous  and  serous 
membranes,  in  tendons  and  cartilages,  as  well  as  in  osseous  system — 
particularly  bones  of  cranium,  ribs,  and  steimum.  The  organs  it  most 
commonly  affects  are  liver,  lungs,  spleen,  pancreas,  Ijniiphatic  glands, 
brain,  eye,  kidneys,  testes,  uterus,  ovaries,  rectum,  and  mamma\  It  is 
sometimes  found  associated  with  various  forms  of  cancer;  and  it  has 
been  met  with  in  the  false  membranes  formed  on  serous  surfaces 
(Andral).  Melanotic  disease  has  a  great  tendency  to  extend  to  differ- 
ent parts  of  the  body  through  the  lymphatic  system. 

Sympto.ms.  In  subcutaneous  melanosis  the  tumors  or  nodules  remove 
all  difficulty  as  to  diagnosis. — When  internal  organs  are  alone  affected, 


MELiENA — MENORRHAGIA.  173 

the  symptoms  are  obscure.  Gradual  sinking  of  the  vital  energies.  A 
cachectic  habit  of  bod}'.  Dusk}'  or  ash-colored  countenance.  Emacia- 
tion.    Dropsy.     Night-sweats.     Gradual  exhaustion. 

It  is  still  a  matter  of  uncertainty  whether  true  nutlanosis  is  simjil}* 
medullar}'  cancer  modified  by  the  formation  of  black  pigment  in  its 
elemental  structures. 

Treatment.  The  symptoms  to  be  combated  as  they  arise.  Chola- 
gogue  purgatives.  Bark  and  mineral  acids.  Ferruginous  tonics.  Nour- 
ishing diet.     Sea  air. 

2.  Spurious  Melanosis. — (1)  From  Introduction  of  Carbonaceous  Matter. 
— The  lungs — it  occurs  only  in  these  organs — present  a  black  carbona- 
ceous color;  bronchial  glands  bhudiened  ;  pulmonary  tissue  indurated 
and  friable,  infiltrated  with  black  serum,  and  often  broken  down  into 
irregular  cavities.  The  discoloration  has  its  origin  in  inhalation  of 
carbonaceous  products  of  ordinaiy  combustion.  Is  chiefly  found  in 
lungs  of  those  who  have  worked  in  coal  mines. 

(2)  From  Action  of  Chemical  Agents  on  the  Blood. — In  digestion  of  coats 
of  stomach  by  gastric  juice  after  death,  and  in  poisoning  by  acids,  the 
blood  contained  in  gastric  capillaries,  as  well  as  that  extravasated,  will 
generally  present  a  blackish  tint.  Inhalation  of  sulphuretted  hydrogen 
gas  will  also  darken  the  blood  in  the  intestinal  capillaries. 

(3)  From  Stagnation  of  Blood. — Retarded  or  impeded  circulation  may 
produce  black  discoloration  of  the  blood.  When  blood  ceases  to  circu- 
late in  capillaries  of  an  organ  it  coagulates,  the  serum  and  salts  become 
absorbed,  and  a  black  substance  remains.  This  probably  consists  of 
fibrine  and  htematin.     Occurs  in  the  digestive  and  respiratory  organs. 

MEL-ffiNA. — From  JA^/a?,  black.  Synon.  Dysenteria  Splenica  ;  Fluxiis 
Splenicu.i ;  Dejectiones  Nigral. — When  the  intestinal  evacuations  contain 
blood,  whether  this  comes  from  vessels  of  stomach  or  only  from  those 
of  intestines,  there  is  said  to  be  mehena.  The  evacuations  are  often  black, 
and  sometimes  resemble  tar;  but  this  dark  appearance  is  by  no  means 
constant,  and  does  not  occur  if  the  blood  comes  away  too  quickly  to  be 
acted  upon  b}'  intestinal  juices.  Cirrhosis  of  liver,  or  any  disease  which 
produces  obstruction  of  portal  sj'stem,  necessarily  gives  rise  to  conges- 
tion of  gastric  and  intestinal  veins;  a  condition  otten  terminating  in 
extravasation  of  large  quantities  of  blood  that  are  thus  expelled. 
Amongst  other  less  common  causes  are  enteritis,  dj'sentery,  intussus- 
ception, simple  and  carcinomatous  ulcerations,  aneurismal  and  other 
tumors,  &c.  Not  to  be  confounded  with  bleeding  from  rectum,  owing 
to  the  presence  of  a  polypus  or  of  haemorrhoids. 

Treatment.  When  there  is  gastric  disease,  see  Hamatemesis.  In 
other  forms:  Calomel  and  jalap,  140.  Podophyllin,  1(30.  Turpentine, 
102.     Gallic  acid,  10.3.     Mineral  acids  and  bitters,  378. 

MELITUEIA. — From  Mlh,  honey  ;  oupnv,  urine.     Sweet  urine. — See 

Diabetes  MeUitus. 

MENORRHAGIA. — From  J/^ive?,  the  menses ;  nywiu,  to  burst  out. 
Synon.  Paramenia  Profusa ;  2£ensirua  Superflua ;  Menorrhoea  ;  Profuse 
Menstruation. — An  abnormal  increase  of  the  catamenia. 

Causes.  May  arise  from  diseases  producing  anaemia  :  Tuberculosis; 
Bright's  disease;  affections  of  spleen;  undue  lactation.  Also  from: 
Excitement  at  monthly  period.  Excessive  sexual  intercourse.  Metritis 
and  ovaritis.  Relaxation  of  uterine  tissue.  Uterine  and  ovarian 
tumors,  &c. 


174  METRITIS MINERAL    DEGENERATION. 

Treatment.  Gallic  acid;  cinnamon;  sulphuric  acid; — either i-emedy 
alone  or  in  combination,  103,  104.  Nitric  acid.  Solution  of  corrosive 
sublimate,  27.  Ergot  of  rj-e.  Ammonio-sulphate  of  iron,  116.  Tur- 
pentine. Opium.  Indian  hemp.  Ipecacuan.  Savin.  Acetate  of  lead. 
Oxide  of  silver.     Arsenic.     Infusion  of  digitalis. 

Local  remedies :  Ice  over  pubes.  Introduction  of  ice  into  vagina. 
Vaginal  injections  of  tannic  acid  or  of  matico.  Astringent  vaginal  pes- 
saries, 423.  Galvanism.  Plugging  os  uteri  with  sponge,  426.  Plugging 
vagina  with  cotton-wool.  Styptic  rod  of  tannin,  424.  Cold  water 
eneniata. — See  Uterine  Hemorrhage. 

METRITIS. — From  M-qzpa,  the  womb;  terminal -«Yi'.s.  Synon.  Fehris 
Uterina  ;  Hysteritis  ;  Inflammatio  Uteri. — Inflammation  of  the  substance 
of  the  unimpregnated  uterus  a  rare  disease.  Muscular  tissue  of  the 
bod}'  may  be  alone  affected,  or  that  of  cervix,  or  that  of  whole  organ 
will  be  involved. 

Symptoms.  Acute  metritis  may  set  in  suddenly  Avith  rigors  followed 
by  fever.  More  commonly,  comes  on  gradually.  Sense  of  fulness, 
weight,  and  heat  about  pelvis.  Throbbing,  with  tenderness,  about 
pubes,  and  groins  and  perineum.  Irritability  of  bladder.  Nausea  and 
vomiting.  Diarrhoea  with  tenesmus.  After  first  day,  acute  paroxysms 
of  uterine  pain.  A  mucous,  sometimes  sanguineous,  discharge.  Suffer- 
ing relieved  by  recumbent  posture. — Acute  symptoms  subside  in  about 
seven  days.  Eesolution  often  occurs.  But  occasionally,  one  or  more 
abscesses  form  in  uterine  parenchyma;  or  subacute  inflammation  fol- 
lows, pelvic  areolar  tissue  getting  involved;  or  fatal  gangrene  sets  in; 
or  it  leaves  hypertrophy  of  uterus,  induration  of  labia,  abrasions,  and 
leucorrhoea. 

Treatment.  Acute  stage:  Complete  re2:»ose.  Simple  diet;  cooling 
drinks;  iced  water.  Hot  hip  baths.  Leeches  to  labia  uteri.  Opium 
and  belladonna  pessaries,  423.  Ice;  sinapisms  to  epigastrium;  a  few 
drops  of  chloroform  on  f?iigar, — for  relief  of  gastric  irritability.  Mucous 
diarrhoea  to  be  checked  by  opiate  enema  or  suppositorj',  339,  340. 

Subacute  stage  :  Iodide  of  potassium  and  aconite,  31.  Corrosive  sub- 
limate, 27.  Mercur}^,  or  iodide  of  lead,  pessaries,  423.  Potassa  fusa  to 
indurated  labia.  Nourishing  food.  Warm  hip  baths.  Moderate  exer- 
cise in  pure  air. 

MILIARIA. — From  Milium,  millet.  Synon.  Miliary  Fever ;  Miliaria 
Swhitoria ;  Exanthema  Miliaria;  Millet-Seed  Rash. — A  vesicular  erup- 
tion; vesicles  the  size  of  millet-seeds,  containing  a  slightly  opaque  fluid, 
and  surrounded  by  a  narrow  red  margin.  Occurs  during  progress  of 
diseases  attended  with  offensive  sweating, — rheumatic  fever,  &c.  Mil- 
iary eruptions  have  occasionally  been  epidemic  (miliary  fever) :  at- 
tended with  much  danger. — See  Sudamina. 

MINERAL  DEGENERATION.— Every  texture  in  the  body  is  proba- 
bly liable  to  mineral  or  earthy  degeneration.  Occurs  most  frequently 
in  the  coats  of  arteries  and  in  cartilages.  Tubercular  and  cancerous 
growths  sometimes  undergo  this  change,  and  so  may  fibroid  tumors  of 
uterus. 

(1)  It  is  important  to  distinguish  between  ossification  and  calcifica- 
tion. Ossijication  docs  sometimes  take  place,  with  formation  of  dense 
or  compact,  and  spongy  or  cancellated  tissue,  and  occasionally  even  of 
periosteum. 

(2)  In  calcification  or  petrifaction  there  is  a  deposit  of  the  salts  of  lime 
in  the  intercellular  substance.     The  coats  of  large  arteries  are  often 


MOLLITIES    OSSIUM — MYALGIA.  175 

found  brittle  from  this  cause.  Sometimes  plates  of  mineral  matter  are 
discovered  embedded  in  the  middle  coat  of  the  vessels,  renderinu;  them 
hard  riu-id  tubes.  So  the  gall-bladder,  pericardium,  &c.,  have  been 
found  converted  into  calcareous  shells. 

MOLLITIES  OBSIUK.— From  Mollis,  soft;  Os,  a  bone.  A  morbidly 
flexible  condition  of  the  bones,  owing  to  an  insuflficienc}"  of  phosphate 
of  lime. — See  Osteomalacia. 

MOLLTJSCUM. — From  Molluscum,  a  fungus  that  grows  on  the  maple 
tree.  Synon.  Ochthiasis  ;  Acne  Molluscoide. — A  rare  cutaneous  disease  : 
of  the  order  Tubercula.  Consists  of  small  tumors;  varying  in  size  from 
that  of  a  pea  to  that  of  a  pigeon's  egg,  occasionally  of  a  brown  color, 
sometimes  growing  from  a  broad  base,  and  sometimes  from  a  narrow 
peduncle.  Two  forms,  one  contagious,  the  other  not.  Contagious  mol- 
luscum very  rare,  severe,  and  chronic.  Non-contagious  molluscum  is 
less  severe;  does  not  produce  so  much  irritation  as  opposite  kind  ;  after 
a  time  the  tumors  neither  grow  nor  alter,  but  remain  stationary  for  life. 
A  cure  can  only  be  effected  by  snipping  off  the  tumors,  or  by  incising 
them  and  apjjlying  nitrate  of  silver. 

MOEBILLI. — The  dim.  of  Morbus,  a  disease;  M6p(K  fiwv,  the  fate  of 
life,  i.  e.,  death. — See  Measles. 

MUSC-ffl  VOLITANTES.— From  Musca,  a  fly;  Volito,  to  fly  about. 
Synon.  Flocci  Volitantes. — Little  specks,  or  floating  black  spots,  which 
fly  over  the  field  of  vision.  Due  to  minute  floating  bodies,  pi'obably 
near  the  retina.  Their  presence  generally  gives  rise  to  very  unneces- 
sary alarm.     Quite  compatible  with  lasting  good  sight. 

MUSCITLAR  TUMOR. — Synon.  Phantom  Tumor. — From  some  pecu- 
liar action  of  diaphragm  and  other  abdominal  muscles,  an  appearance 
results  exactly  resembling  that  caused  by  a  large  foreign  body.  Some- 
times simulates  pregnancy, — Spurious  pregnancy ;  Gr'ossesse  simulee  par 
illusion  pure  of  French  authors.  Has  been  mistaken  for  ovarian  tumor. 
— An  erroneous  sensation  of  a  small  tumor  often  communicated  to  the 
hand  by  irregular  contractions  of  recti  muscles,  in  sensitive  subjects. 

Symptoms.  Abdominal  cavity  appears  to  be  entirely  or  partially 
filled  by  a  foreign  body,  or  by  pregnant  uterus.  Swelling  may  be  firm 
and  unyielding;  or  it  changes  its  position  from  day  to  day;  or  aj^pears 
movable,  and  as  if  attached  by  a  pedicle.  Sometimes,  tenderness  on 
pressure.  Borborygmi  on  auscultation.  Resonance  on  percussion,  un- 
less there  be  much  fat.  Arching  forwards  of  lower  dorsal  and  upper 
lumbar  vertebraj.  Swelling  occasionally  melts  away  under  influence 
of  prolonged  manipulation  :  always  dispersed  on  placing  patient  under 
full  influence  of  chloroform. 

General  health  usually  bad.  Anaemia.  Hysteria.  Irregulai'ity  of 
uterine  functions.     Dyspepsia.     Ovarian  iwitation  :  uterine  disease. 

Treatment.  Improvement  of  general  health.  Cure  of  uterine  or 
ovarian  disease. — Bark  and  mineral  acids,  376.  Quinine,  .379.  Quinine 
and  steel,  380.  Quinine  and  nux  vomica,  387.  Steel  and  aloes,  393, 
404.  Strychnia  and  steel,  408.  Zinc  and  nux  vomica,  409.  Valerianate 
of  zinc,  410.  Hypophosphite  of  soda,  419.  Cod-liver  oil.  Nourishing 
diet. — Galvanism.  Sea  bathing.  Shampooing.  Support  by  abdominal 
belt  or  bandage. 

MYALGIA. — From  Muq,  a  muscle ;  aX^'iw,  to  suffer  pain. — Stiffness, 


176  MYCETOMA — MYELITIS. 

cramp,  soreness,  or  pain,  in  the  voluntary  muscles  or  their  tendinous 
pi'olongations.  Arises  from  fatigue. — Muscles  of  trunk  more  commonly 
attacked  than  those  of  extremities;  of  abdominal  walls,  than  of  thoracic; 
and  of  legs,  than  of  arms.  Tendinous  parts  more  frequently  the  seat 
of  pain  than  the  fleshy  ;  the  portions  of  tendons  usuallj'  aifected  being 
the  spot  where  they  are  inserted  into  bone,  or  where  the  tendinous  joins 
the  muscular  fibre  (Inman). 

Myalgia  common  during  progress  of  scurvy,  tuberculosis,  cancer, 
chlorosis,  leucocythemia,  chronic  dysentery  or  diarrhosa,  prolonged  lac- 
tation, exhausting  uterine  disease,  &c.  Also  during  convalescence  from 
hemorrhage,  severe  inflammation,  parturition,  continued  fevers,  &c. 

Symptoms.  Pain:  severe  in  proportion  to  the  general  debility:  aggra- 
vated by  an}'  movement  which  calls  affected  muscle  into  play:  seldom 
conjplained  of  in  the  morning  after  a  good  night's  rest,  but  soon  follow- 
ing upon  a  few  hours'  exertion,  and  gradually  increasing  towards  night. 
General  health  more  or  less  depressed.  Skin  cool.  Pulse  natural,  or 
feeble  and  somewhat  quickened.  Appetite  good.  Tongue  clean. — In 
exceptional  cases, — fever;  night  sweats;  loss  of  appetite;  impaired 
digestion;  constipation;  a  disinclination  for  work  of  any  kind;  severe 
mental  depression. 

Treatment.  Quinine,  379.  Quinine  and  steel,  380.  Cod-liver  oil, 
389.  Steel  and  cocoa-nut  oil,  391.  Steel  and  glycerine,  392.  Steel  and 
pepsine,  394.  Phosphate  of  iron,  405.  Hypophospliite  of  soda  and 
bark,  419.  Morphia,  chloroform,  and  Indian  hemp,  317.  Subcutaneous 
injection  of  morphia,  or  chloroform,  314.  Ether  spray.  Linseed  poul- 
tices, with  belladonna  and  opium,  297.  Friction  with  belladonna  lini- 
ment, 281.  Partial  rest  of  affected  muscle  to  be  insured  by  bandage; 
strips  of  belladonna  or  opium  plaster.  Galvanism.  Shampooing. — 
Animal  food:  milk,  or  cream:  raw  eggs:  wine,  or  malt  liquors,  or 
whiskey,  brandy,  &c. 

MYCETOMA. — From  Muxrjc;,  rjroi;,  the  mushroom.  Synon.  Fungus  Foot 
of  India. — A  destructive  parasitic  disease.  The  mucedinous  fungus 
{Chionyphe  Carferi)  eats  its  way  into  the  metatarsal  and  tarsal  bones, 
and  ultimately  into  lower  extremities  of  tibia  and  fibula.  Numerous 
fistulous  channels  result,  becoming  filled  with  rounded  black  masses  of 
fungus.  Observed  onl}-  in  natives  of  India,  who  go  about  with  naked 
feet.  Sporules  of  the  fungus  get  introduced  beneath  the  cuticle,  through 
some  scratch  or  abrasion.  Amputation  seems  to  be  the  only  remedy  of 
any  use. 

MYELITIS. — From  MueXbq.,  marrow;  terminal  -itis.  Synon.  Spinodor- 
sltis ;  Machialgitis ;  Inficwimatio  Medullm  Spinalis. — Inflainraation  of  the 
substance  of  the  spinal  cord  is  a  rare  disease.  Sometimes  coexists  with 
pneumonia,  gastro-enteritis,  and  continued  fever.  May  be  excited  by 
cold,  damp,  wounds,  contusions,  &c.  Often  ends  in  softening,  or  sup- 
puration. 

Symptoms.  Not  very  uniform.  If  cranial  portion  of  cord  be  affected  : 
Deep-seated  headache;  convulsive  movements  of  head  and  face;  inar- 
ticulate speech ;  trismus ;  difficult  deglutition ;  impeded  spasmodic 
breathing;  irregular  action  of  heart;  hemiplegia,  or  other  form  of 
paralysis.  If  about  to  prove  fatal  in  acute  stage,  great  prostration;  in- 
creased dyspno3a;  involuntary  escape  of  excretions.  When  whole  thick- 
ness of  cord  above  origin  of  phrenic  nerves  is  attacked,  death  occurs 
rapidly  from  cessation  of  respiratory  movements. — Inflammation  of 
cervical  portion:  Difficult  deglutition;  impossibilit}^  of  raising  or  sup- 
porting head;  acute  pain  in  back  of  neck;  urgent  dyspnoea;  sense  of 


MYOCARDITIS — MYOSITIS.  177 

pricking  aiul  formication  in  arms  and  bands;  ])aralysis  of  upper  ex- 
tremities.— Of  dorsal  region:  Pain  over  affected  part;  numljness  or 
pricking  sensations  in  fingers  and  toes  ;  convulsive  movements  of  ti-unk; 
paralysis  of  arms  and  lower  extremities;  dyspnoea;  great  palpitation. — 
Of  lumbar  portion  :  Marked  paralysis  of  lower  extremities  at  early 
period;  abdominal  pain,  with  sensation  as  of  a  cord  tied  tightly  round 
body  ;  convulsions  ;  retention,  followed  by  incontinence  of  urine,  owing 
to  paralysis  of  bladder;  involuntary  stools,  from  paralysis  of  sphinc- 
ter ani. 

Pain  in  affected  part  of  cord  less  severe  than  in  meningitis:  increased 
by  application  of  heat  (as  of  hot  sponge),  and  by  pressure.  Bed-sores 
very  apt  to  form. 

Treatment.  Calomel  and  jalap,  140,  159.  Jalap  and  senna,  151. 
Castor  oil  and  turpentine  enema,  190.  Corrosive  sublimate  and  sai-sa- 
parilla,  27.  Iodide  of  potassium,  31.  Great  care  necessary  to  keep 
patient  dry  and  clean.  Bladder  to  be  emptied  by  catheter,  unless  urine 
be  passed  freely.  Bed-sores  to  be  prevented  by  amadou  plaster,  water- 
bed,  &e. 

MYOCARDITIS. — From  J/tJ-,  a  muscle;  y.ap8ia,  the  heart;  terminal 
-itis.     Synon.   Carditis. — Inflammation  of  muscular  substance  of  heart. 

Seldom  occurs  as  a  distinct  affection  :  generally  combined  with  peri- 
carditis, or  endocarditis,  or  both.  Walls  of  left  ventricle  suffer  more 
frequently  than  other  parts. — Eesults, — induration  of  muscular  struc- 
ture from  deposit  of  lymph;  formation  of  abscesses;  aneurismal  dila- 
tation of  walls  of  heart;  softening  of  heart,  and  possibly,  rupture. 

MYOPIA. — From  Mom,  to  contract;  w^^,  the  eye.  Sjnion.  Hypome- 
tropia;  Short-sightedness ;  Near-sightedness.— \^ hew  the  distance  at  which 
ordinary  type  can  be  easily  read  is  less  than  twelve  inches,  the  vision 
is  said  to  be  mj'opic.  Near  objects  are  seen  distinctly.  Myopia  most 
frequently  arises  from  too  great  a  convexity  of  the  cornea,  or  of  the 
crystalline  lens,  or  both.  May  be  owing  to  a  lengthening  of  the  eye- 
ball: to  an  undue  density  of  any  or  of  all  the  refractive  media.  The 
rays  of  light  from  objects  at  the  usual  distance  are  brought  to  a  focus 
before  they  j-each  the  retina,  instead  of  being  concentrated  upon  it. 
Sometimes  associated  with  strabismus.  Myopia  rarel}^  decreases  as  age 
advances,  though  popularly  believed  to  do  so.     It  is  often  hereditar}'. 

In  many  cases  of  short-sightedness  the  iris  is  either  preternaturally 
contracted,  or  it  possesses  unusual  irritability.  This  occurs  especially 
in  individuals  of  a  very  nervous  temperament.  Exposure  to  bright 
light  aggravates  this  condition.  Snow-blindness  chieflj^  due  to  it ;  con- 
sisting, in  a  great  measure,  of  excessive  contraction  of  pupil. 

Treatment.  Avoidance  of  overwork,  examination  of  minute  ob- 
jects, &c.,  especially  by  gaslight. — Well-adjusted  double  concave  glasses 
or  spectacles:  single  eye-glasses  are  bad.  The  greater  the  degree  of 
short-sightedness,  the  greater  must  be  the  concavity  of  the  glassed.  The 
glasses  had  better  be  worn  only  when  required.  Heat  and  congestion 
about  the  eyes  to  be  relieved  by  the  eye  douche.  Where  the  iris  is 
unusually  irritable  belladonna  gives  relief  Where  there  is  disease  of 
choroid,  a  prolonged  course  of  corrosive  sublimate  in  small  doses. 

MYOSITIS. — From  J/uc,  a  muscle;  terminal  -itis.  Synon.  Myitis; 
Sarcitis;  Infiammatio  Musculorum. — Inflammation  of  muscular  fibre  is  a 
rare  affection.  May  occur  from  injury,  over-exertion,  disease  of  adjoin- 
ing textures,  &c. 

Symptoms.     Pain :  greatly  aggravated  by  any  movement  of  affected 

12 


178  N^vus. 

mnscle.  Heat  and  swelling;  the  latter  often  distinct,  simulating  a 
tumor.  Symptomatic  fever.  May  terminate  in  induration;  or  soften- 
ing; or  suppuration  ;  or  even  gangrene. 

Treatment.  Hot  fomentations.  Best.  Opium.  Nourishing  food, 
in  proportion  to  the  failure  of  general  strength. 

NiEVUS. — As  if  Gitccmis,  from  yvAu),  whence  yiyvvj,  to  be  born  ;  because 
the  blemish  is  congenital.  Synon.  Na'vus  Matermts ;  Mother's  Mark; 
Erectile  or  Vascular  Tumor;  Aneurism  by  Anastomosis — A  growth  formed 
by  enlarged  and  dilated  arteries,  veins,  or  capillary  vessels. 

Symptoms.  Arterial  navi  more  commonly  begin  in  youth  than  in- 
fancy. The  diseased  vessels  become  enlarged  and  elongated  and  tor- 
tuous; forming  a  tumor  of  irregular  sha])e,  which  is  spongy  and  com- 
pressible and  pulsating.  A  loud  superficial  bruit  is  audible. —  Venous 
nsBvi  give  rise  to  irregular  tumors  of  a  jjurple  color ;  which  feel  doughy, 
and  are  diminished  in  size  by  pressure.  They  may  be  as  small  as  a  nut, 
or  as  large  as  an  orange. — Capillary  nsevi  most  common.  Usually  con- 
genital. Commence  as  vivid  red  or  purplish  spots,  which  gradually 
spread.  May  affect  the  skin  and  subcutaneous  areolar  tissue  of  any 
part:  more  commonly  met  with  on  scalp  or  face  or  neck,  than  on  back 
or  buttocks  or  organs  of  generation. — Nffivi  of  a  mixed  character  not 
rare. 

Treatment.  When  small,  producing  no  disfigurement,  and  not  in- 
creasing in  size  they  are  best  left  alone.  Occasionally,  spontaneous  cure 
occurs.  Interference  being  necessary  attempts  must  be  made, — to  ex- 
cite adhesive  inflammation  so  as  to  coagulate  the  blood  and  obliterate 
the  vessels;  or  to  destroy  the  growth  by  caustics;  or  to  effect  removal 
by  knife  or  ligature. 

(1)  To  excite  adhesive  inflammation  :  Vaccination,  making  several  punc- 
tures at  circumference  of  spot  and  one  or  two  on  surface,  so  as  to  pro- 
duce a  confluent  vesicle.  Compression;  by  a  piece  of  sheet-lead  and 
bandage,  or  painting  with  collodium,  or  by  the  finger  applied  for  some 
hours.  Frictions  with  compound  iodine,  or  croton  oil,  or  red  iodide  of 
mercury,  or  tartarated  antimony  ointments.  Congelation.  Dotting  the 
surface  with  a  small  and  pointed  actual  cauf  ery.  Setons  ;  passing  several 
threads  with  a  common  sewing-needle  in  all  directions  across  the  tumor, 
and  leaving  them  until  suppuration  is  excited.  Breaking  up  substance 
of  growth,  subcutaneouslj",  by  a  common  dissecting  needle.  Injection 
of  a  few  drops  of  tincture  of  perchloride  of  iron  with  a  sharp-pointed 
syringe. — Passing  a  needle  under  the  growth,  when  small,  and  twisting 
a  thread  around  it  so  as  to  cause  considerable  pressure,  and  allowing  it 
to  remain  for  forty-eight  hours  (Fergusson).  —  Introduction  of  two 
needles,  at  right  angles  to  each  other,  under  the  mass,  and  winding  of 
a  ligature  round  the  whole.  Immediate  withdrawal  of  needles;  ligature 
to  be  untied  in  four  hours.  A  scab  forms,  which  drops  off  in  ten  or 
fourteen  days;  no  suppuration  nor  open  sore.  Without  destroying  the 
nffivus,  sufficient  obstruction  is  caused  to  allow  the  blood  in  the  tissue 
to  get  consolidated  (Cooper  Forster). 

(2)  Destruction  by  caustics:  Nitric  acid,  or  acid  solution  of  nitrate  of 
mercury,  repeated  once  or  oftener.  Potassa  fusa.  Acetic  acid.  Super- 
sulphate  of  zinc,  198.  Actual  cautery;  free  application,  so  as  to  insure 
complete  destruction. 

(3)  Removal  by  knife  or  ligature:  Use  of  knife  very  rarely  advisable: 
if  employed,  the  incisions  must  be  made  wide  of  the  disease,  or  hemor- 
rhage will  be  great. — Ligature,  safe  and  convenient :  may  be  used  in 
many  ways.  Amongst  other  plans,  the  ligatures  may  be  passed  subcu- 
';aneously  around  the  nsevus,   and  tightened  so  as  to  strangulate  it, 


NASAL    LIPOMA — NEPHRITIS.  179 

without  involving  the  skin.  Or  a  needle  carrying  a  douhle  thi-cad  can 
he  passed  through  the  centre  of  the  base  of  the  growth,  and  the  liga- 
tures tied  round  each  hemispherical  division,  first  making  an  incision 
or  groove  through  the  skin  in  which  the  ligatures  may  lie.  In  either 
case,  the  ligatures  may  have  to  be  tightened  in  four  or  five  days.  As 
gi-anulations  form,"any  tendency  to  nrovus  growth  Ynust  be  checked  by 
application  of  nitric  acid. — In  naevi  within  the  orbit,  or  in  other  inac- 
cessible parts,  it  has  been  found  necessary  to  tie  the  nutrient  vessel : 
ligature  of  the  common  carotid  has  been  resoi-ted  to  under  such  cir- 
cumstances. 

NASAL  LIPOMA.— From  Aimx;,  fat. — Hypertrophy  of  skin  and  sub- 
cutaneous tissue  of  apex  and  ala3  of  nose.  Most  common  in  men,  who 
are  advanced  in  years  and  have  lived  very  freely.  When  the  growth  is 
considerable,  a  cure  can  only  be  effected  by  paring  off  the  redundant 
tissue.  In  other  cases,  increase  in  size  may  be  prevented  by  careful 
diet ;  avoidance  of  intoxicating  drinks ;  frequent  nse  of  astringents 
washes. 

NASAL  POLYPUS. — From  TJoru^,  many;  noh^,  a  foot.  A  tumor  so 
named  because  it  was  suj^posed  to  have  numerous  attachments  or  feet. 
Nasal  polypi  are  of  three  kinds:  Mucous,  or  gelatinous;  fibrous;  and 
medullary. 

Symptoms.  A  sense  of  stuffiness  in  one  or  both  nostrils.  Frequent 
desire  to  blow  the  nose,  with  no  relief  on  doing  so.  Increased  mucous 
discharge.  Attacks  of  bleeding — epistaxis.  Imj^airment  of  smell  and 
taste.  When  uninterfered  with,  displacement  of  septum  of  nose;  deaf- 
ness from  pressure  on  Eustachian  tube;  indistinctness  of  articulation; 
deformity  of  cheek,  from  expansion  of  bones;  obstruction  to  tears;  and 
even  fatal  cerebral  pressure.  These  tumors  verj'^  apt  to  return  again 
and  again  after  removal. 

Treatment.  Eemoval  by  strong,  toothed,  slightly  curved  forceps, 
applied  to  neck  of  growth,  so  as  to  twist  it  off. 

NECROSIS. — From  NsxpdcD,  to  produce  mortification  or  decay.  Synon. 
Osteonecrosis ;  Osteogangra'tia. — Mortification  or  death  of  a  bone,  or  por- 
tion of  a  bone.  The  term  usually  restricted  to  one  form;  in  which  part 
of  the  shaft  of  a  cylindrical  bone  dies,  and  is  inclosed  in  a  case  of  new 
bone.  Exfoliation  signifies  necrosis  of  a  thin  superficial  layer,  which  is 
not  incased  in  any  shell  of  new  bone  (Druitt). 

Frequently  attacks  the  tibia  in  children:  the  phalanges,  from  whit- 
low: the  skull  and  clavicle,  from  sj'philis.  May  arise  from  mechanical 
injury,  or  from  inflammation  however  set  up.  A  peculiar  fbrm  of  ne- 
crosis of  the  lower  jaw  occurs  amongst  the  makers  of  lueifer  matches,, 
being  produced  by  the  fumes  of  phosphorus. 

Symptoms.  Indications  of  acute  osteitis.  Suppuration,  with  forma- 
tions of  sinuses,  or  cloacae;  through  which,  on  passing  a  probe,  the  bare 
dead  bone  (the  sequestrum)  can  be  touched.  Abundant  fetid  discharge. 
Inflammatory  fever.  Separation  of  sequestrum  from  the  living  bone 
after  a  variable  interval.     Disease  very  chronic. 

Treatment.  Incision  and  removal  of  sequestrum  as  soon  as  it  is 
detached,  and  when  it  can  only  act  as  an  irritating  foreign  body. 

NEPHRITIS.— From  Nefpdc;,  the  kidney;  terminal  -<Y<s.— Under  this 
head  may  be  arranged  for  convenience:  Inflammation  of  the  substance 
of  the  kidney;  acute  desquamative  nephritis;  chronic  desquamative 
nephritis. 


180  NEPHRITIS. 

1.  Nephritis. — Sjnon.  Nephrophlegmone ;  Inflammatio  Renum;  Inflam- 
mation of  Substance  of  Kidney. — Comparativelj-  a  rare  disease.  May  , 
arise  without  appreciable  exciting  cause,  especiallj^  in  strumous  sub- 
jects; from  exposure  to  cold  and  damp;  gravel  and  calculi;  mechanical 
injuries;  poor  living  combined  with  intemperance;  abuse  of  diuretics; 
use  of  cantharides,  oil  of  turpentine,  Arc.  Morbid  action  either  ends  in 
resolution  ;  or  it  goes  on  to  su])puration,  variable  sized  abscesses  re- 
sulting, which  sometimes  destroy  entire  gland. — When  disease  is  con- 
fined to  mucous  lining  of  pelvis  and  infundibula,  it  is  known  as  pyelitis. 

Symptoms.  Severe  pains  in  loins,  increased  by  pressure  or  exercise: 
pain  often  extending  along  ureter  to  neck  of  bladder,  groin,  scrotum, 
or  testicle.  Numbness  of  thigh  :  retraction  of  testicle.  Much  constitu- 
tional disturbance:  shivering,  fever,  nausea  and  vomiting,  hard  and  fre- 
quent and  full  pulse,  constipation,  tj-mpanites.  Frequent  and  urgent 
desire  to  empty  bladder:  urine  high-colored,  often  contains  renal  casts 
with  blood  and  pus  corpuscles.  Sometimes,  suppression  of  urine;  with 
urtemia,  convulsions,  and  coma.  When  recovery  follows,  foundation  for 
future  renal  disease  often  laid. 

Where  one  or  more  abscesses  form,  thej^  perhaps  lead  to  ulceration, 
perforation  of  capsule,  renal  fistulse,  and  establishment  of  a  purulent 
discharge.  Sometimes,  fatal  hectic  fever.  In  more  favorable  cases,  pus 
passes  away  by  natural  passages  and  is  found  in  the  urine. — Eenal  ab- 
scess may  also  be  a  secondar}'  affection  :  due  to  irritation  of  a  calculus, 
obstructive  diseases  of  urinar}'  passages,  &c. 

Treatment.  Hot  hip  baths.  Vajjor,  or  hot  air  baths.  Fomenta- 
tions. Mild  aperients.  Diaphoretics,  especially  such  as  contain  opium 
if  there  be  no  ura?mic  symptoms.  Rest  in  bed,  preferably  between 
blankets.  Low  diet;  with  tea,  milk,  ice,  and  simple  diluents.  Sinapisms 
to  epigastrium  if  there  be  sickness. — Stimulants,  tonics,  and  support  as 
soon  as  prostration  sets  in,  or  there  are  indications  of  suppuration. — 
See  Urcemia. 

2.  Acute  Desquamative  Nephritis. — Sj-non.  Acute  Diffuse  Nephritis; 
Acute  Albuminous  Nephritis;  Acute  Bright' s  Disease ;  Acute  Inflammatory 
Dropsy.  —  Has  its  origin  in  many  causes,  —  intemperance,  starvation, 
exposure  to  wet  and  cold,  but  especially  scarlet  fever. — Consists  essen- 
tially of  disease  of  epithelial  cells  lining  convoluted  uriniferous  tubes; 
induced  by  their  having  to  eliminate  from  the  blood  some  matter  not 
naturally  excreted  by  kidneys.  Functions  of  cells  being  modified,  they 
^become  atrophied  and  disintegrated :  from  their  rapid  desquamation 
they  check  secretion  by  mechanically  obstructing  the  tubes.  Circula- 
tion through  vessels  of  Malpighian  tuft  becomes  impeded  :  hence  effu- 
sion of  serum  and  fibrine  into  cavities  of  tubes.  The  serum  exuded  from 
congested  Malpighian  ca])illaries  mingles  with  the  urine,  rendering  it 
.albuminous:  the  fibrinous  material  solidifies,  entangles  the  cast-off  celli^, 
;and  escaping  Avith  urine  is  detected  as  epitlielial  tube-casts.  If  walls  of 
.an}'  vessels  give  way,  blood  corpuscles  will  also  be  found  entangled  in 
ithe  casts;  and  urine  will  present  a  dark-colored  sediment. 

Occasionally  there  is  general  dropsy  and  albuminuria  without  des- 
'quamation  of  renal  epithelium — non-desquamative  disease  of  kidney. 
Often  attended  with  prominent  symptoms  of  blood-poisoning;  owing 
to  some  failure  and  imperfection  in  effort  to  eliminate  morbid  material 
.from  sj'stem  (George  Johnson). 

Sy.mptoms.  Chilliness,  rigors:  soon  followed  by  feverish  reaction, 
'headache,  thirst,  restlessness,  pain  and  tenderness  about  loins,  vomiting. 
Dro])S3-:  face  first  becomes  puffy,  then  general  oedema  and  effusion  of 
serum  into  one  or  more  of  serous  cavities.     Frequent  micturition:  urine 


NEURALGIA.  181 

scanty,  of  a  dark  smoky  color,  higlily  all)Uininous,  abundance  of  epithe- 
lial casts  and  cells,  &c. — Earliest  signs  of  amendment, — disappeai-ance 
or  lessening  of  dropsy;  increase  in  quantity  of  urine;  steady  diminu- 
tion of  albumen.     In  unfavorable  cases, — supjjression  of  urine;  ura'mia. 

Treatment.  At  onnet :  Confinement  to  bed;  preferably  between 
blankets.  Low  diet:  free  allowance  of  milk,  tea,  cold  water,  barley 
water,  lemonade,  ice.  Hot  water  batlis.  Blanket-baths,  136.  Hot  air, 
or  vapor  baths.  Dry  cupping  to  loins.  Linseed  poultices  to  loins. 
Compound  jalap  powder.  Sulphate  and  carbonate  of  magnesia,  14L 
Sulphate  of  magnesia  and  antimonial  wine,  152.  Eesin  of  podoplnllum, 
160.  Elaterium,  157.  Solution  of  acetate  of  ammonia.  Citrate  of 
potash.  Nitrate  of  potash  and  nitrous  ether,  212. — At  end  of  a  few  daya : 
Tincture  of  perchloride  of  iron,  392,  897.  Phosphate  of  iron,  405. 
Iron-aiuMi,  116.  Quinine.  Animal  food;  milk;  raw  eggs.  Bordeaux 
or  Hungarian  wines.  Warm  clothing  :  flannel  next  the  skin.  Avoid- 
ance of  spirits  and  beer:  of  exposure  to  cold  and  damp. — For  unemic 
poison. — See  Urcemia. 

Remedies  occasionally  employed :  Bloodletting.  Capping.  Leeches. 
Blisters.  Tartarated  antimony.  Colchicum.  Digitalis  and  broom. 
Digitalis  and  acid  tartrate  of  potash.     Chloroform. 

3.  Chronic  Desquamative  Nephritis. — Synon.  Chronic  Diffuse  Nephritis ; 
Chronic  Bri(jht's  Disease;  Gouty  Kidney. — Characterized  b}'  long-con- 
tinued shedding  of  renal  epithelium,  which  appeal's  in  urine  in  a  more 
or  less  disintegrated  state.  The  tubes  lose  their  epithelial  lining,  and 
become  atrophied  or  filled  with  new  material;  or  sometimes  get  dilated 
into  cysts.  Kidney  becomes  granular  and  contracted.  Urine  albu- 
minous: of  a  low  density:  contains  granular  epithelial  casts. — Cc>mes 
on  insidiously.  May  result  from  acute  desquamative  nephritis:  more 
frequently  due  to  chronic  gout,  or  some  allied  disorder. 

Symptoms.  Eun  their  course  slowly.  Health  gradually  fails.  Debil- 
ity and  loss  of  flesh.  Produces  great  changes  in  the  blood.  Anasarca; 
dropsy  of  one  or  more  serous  cavities.  Inflammation  of  serous  mem- 
branes. Hypertrophy  of  heart :  perhaps  valvular  disease.  Structural 
changes  in,  or  great  functional  disturbance  of,  nervous  centres. 

Treatment.  Removal  of  prominent  symptoms.  Simple  nourishing 
food.  Attention  to  functions  of  skin.  Cure  of  any  gouty  afl'ection. 
Improvement  of  blood  by  ferruginous  tonics.     Sea  air. 

NEURALGIA. — From  Nsopav,  a  nerve ;  aXyo^,  suffering.  Synon. 
Neurodynia ;  Nervous  Pang. — Violent  pain  in  the  trunk  or  branch  of  a 
nerve,  occurring  in  paroxysms,  perhaps  at  nearly  equidistant  intervals. 
May  attack  nerves  of  head,  trunk,  or  extremities:  subcutaneous  nerves 
of  these  regions  suffer  most  frequently. 

Varieties.  When  the  pain  aft'ects  branches  of  fifth  pair  of  nerves, 
— neuralgia  faciei,  or  tic  douloureux:  certain  nerves  about  head, — herni- 
crania ;  sciatic  nerve, — sciatica.  Some  authorities  regard  angina  pectoris 
as  neuralgia  of  cardiac  nerves :  gastrodynia,  as  a  similar  disease  of 
nerves  of  stomach. 

(1)  Tic  Douloureux:  May  affect  either  of  three  branches  of  fifth 
pair  of  nerves.  Where  pain  depends  upon  morbid  condition  of  first  or 
ophthalmic  branch,  the  frontal  i-amification  of  it — supra-orbital  nerve — 
is  most  frequently  attacked:  suftering  i*eferred  chiefly  to  forehead. 
Supposing  second  or  superior  maxillary  branch  is  seat  of  complaint, 
infra-orbital  nerve  most  commonly  aftected  :  s^-mptoms  consist  of  excru- 
ciating pain  shooting  over  cheek,  lower  eyelids,  alffi  of  nose,  and  upper 
lij).     Tic  douloureux  of  third  or  inferior  maxillary  branch  is  generally 


182  NEURITIS. 

confined  to  inferior  dental  nerve,  especially  to  portion  which  emerges 
from  mental  foramen  and  extends  to  lower  lip;  pain  referred  to  lower 
lip,  alveolar  process,  teeth,  chin,  and  side  of  tongue. 

AVliichever  ner%'^e  suffers,  the  torture  is  equally  confined  to  one-half 
of  face.  Eight  infra-orbital  nerve  most  frequent  seat.  Attack  comes 
on  suddenly,  patient  at  once  putting  up  hand  to  press  the  seat  of  suffer- 
ing: it  greatly  increases  in  severity,  gets  lancinating  and  burning,  and 
then  ceases  in  coiirse  of  a  few  seconds.  Attacks  perhaps  preceded  by 
derangement  of  digestive  organs;  by  dyspnoea;  by  slight  rigors,  fol- 
lowed by  heat.  Sometimes  absent  for  weeks,  and  then  almost  constant 
paroxysms  for  many  days. — May  be  due  to  dyspepsia  ;  anaemia  ;  renal 
disease;  disease  of  facial  bones;  organic  disease  of  brain;  disease  of 
teeth  or  gums;  poison  of  malaria,  &c. 

(2)  Hemicrania :  Headache  affecting  one  side  of  brow  and  forehead. 
Often  accompanied  with  sickness.  Sometimes  periodical.  Has  been  called 
Sun-pain,  as  at  times  it  only  continues  so  long  as  sun  is  above  hoi'izon. 

(3)  Sciatica:  Acute  pain  following  course  of  great  sciatic  nerve. 
Extends  from  sciatic  notch  down  })OSterior  surface  of  thigh  to  popliteal 
space,  and  often  along  nerves  of  leg  to  foot.  May  be  due  to  pressure  of 
intestinal  accumulations,  of  simple  or  malignant  uterine  tumors.  Other 
causes, — inflammation,  rheumatism,  gouty  or  syphilitic  taint,  malaria, 
over- fatigue,  exjiosure  to  cold  and  wet. 

Treatment.  Eemoval  of  cause.  Improvement  of  health.  Purga- 
tives, only  if  actuall}'  required.  General  remedies:  Nourishing  diet: 
regulated  amount  of  bitter  ale,  stout,  or  other  alcoholic  stimulants: 
raw  eggs  :  milk,  in  place  of  tea  and  coffee.  AVarm  clothing :  flannel  next 
the  skin  or  chamois  leather  jackets  and  drawers.  Warm,  tepid,  or  cold 
salt  water  baths.     Turkish  bath.     Friction  of  skin. 

Drugs:  Aloes,  gentian,  and  liquor  potassie,  148.  Sulphate,  or  phos- 
phate, of  soda,  148,  149.  Pepsine  and  aloes.  155.  Croton  oil  (in  sciatica 
from  fecal  accumulation),  168,  191.  Quinine,  379.  Quinine,  steel,  and 
arsenic,  381.  Cod-liver  oil,  389  Iodide  of  iron  and  cod-liver  oil,  390. 
Steel  and  pepsine,  394.  Steel  and  arsenic,  399.  Phosphate  of  iron,  4U5. 
Strjx'hnia  and  steel,  4U8.  Valerianate  of  zinc,  quinine,  steel,  or  ammonia, 
4lU.  Sulphate  of  zinc,  413.  Ilypophosphite  of  soda  or  lime,  419. 
lodideof  potassium.  31.  Gnaiacum  and  aconite,  48,  380.  Colchicum,  40. 
Turpentine,  50.  Hydrocblorate  of  ammonia,  60.  Opium,  340,  345. 
Morphia,  &c.,  317.  Hj-podermic  injections  of  morphia,  or  atropine,  or 
aconitine,  314.  Chloroform  inhalation,  313.  Stramonium,  323.  Bella- 
donna, or  atropia,  826.  Digitalis,  834.  Conium.  Galbanum.  Glonoin. 
Oxygen  inhalation.  Salicin.  Sabadilla.  Sulphate  of  beberia.  Arnica. 
Musk. 

Topical  expedients:  Division  of  affected  nerve.  Eemoval  of  tumors 
and  foreign  bodies.  Extraction  of  decayed  teeth.  Application  of  iodine. 
Blisters,  dusting  raw  surface  Avith  morphia.  Spray  of  pure  ether. 
Aconitine,  296.  Yeratria,  304.  Belladonna,  Avith  opium  or  mercury, 
297,  298.  Chloroform,  belladonna,  and  aconite,  281,  282.  Belladonna 
and  glycerine,  265.  Hypodermic  injections  of  morphia,  &c.,  314.  Cyan- 
ide of  potassium.  Hot  douches  of  medicated  water.  Continuous  gal- 
vanic current.     Acupuncture.     Dry  cupping. 

NEURITIS. — From  Nsdpnv,  a  nerve;  terminal  -itis.  Synon.  Neuro- 
phlogo-sis ;  Xeurophlegmone. — Inflammation  of  a  nerve  is  a  rare  disease. 
Usually  due  to  a  bruise  or  wound,  or  to  inclusion  of  some  nervous 
branch  in  a  ligature  when  taking  up  an  artery.  May  perhaps  arise 
spontaneously  in  gouty  or  rheumatic  subjects. 

Symptoms.     Severe  and  continuous  pain  along  trunk  of  nerve  and  its 


NEUROMA — OBESITY.  183 

ramifications.     Fever.     Eestlessness,  especially  at   night.     In  chronic 
form,  symptoms  of  neui'ulgia. 

Treatment.  Iodide  of  potassium.  Aconite.  Colchicum.  Local  use 
of  belladonna.  Hypodermic  injection,  in  neighborhood  of  pain,  of 
morphia  or  aconite,  814.  Fomentations.  Water-dressing.  Eest  of 
atf'ected  part. 

NEUROMA. — From  jXedpov,  a  nerve. — A  solid  or  cystic  tumor  con- 
nected w  ilh  a  nerve.  Solid  growths  are  of  a  fibrous  nature,  consisting 
of  dense  plastic  matter,  implicating  neurilemma  and  nerve-fibres.  Oc- 
casionally, nerve-fibres  merely  spread  over  tumor,  without  being  in- 
volved in  its  texture. 

Neuromatous  tumors  may  form  spontaneously.  Single,  more  y)uinfiil 
than  multiple,  growths.  May  result  from  a  wound  or  other  injury: 
occasionally  produced  on  ends  of  nerves  after  amputation. 

Symptoms.  Neuromatous  growths  vary  in  size  from  a  barlej'corn  to 
a  melon.  Occur  most  frequently  on  spinal  nerves  :  branches  of  gan- 
glionic system  very  rarely  affected.  Growth  steady  but  slow.  Of  an 
oval  or  oblong  form;  long  axis  corresponding  with  direction  of  nerve 
to  which  there  is  attachment.  Darting  pains:  much  increased  by 
moving  tumor  in  direction  of  nerve. — In  traumatic  neuroma,  growth 
single:  source  of  paroxysmal  pains,  like  shocks  of  galvani.sm. 

Treatment.  Excision  otters  the  only  hope  of  cure.  Tumor  to  be 
carefully  dissected  out,  if  possible.  When  complete  excision  is  adopted, 
the  ends  of  divided  nerve  to  be  brought  into  apposition  by  sutures  :  by 
maintaining  continuity  thei-e  is  no  loss  of  power  in  parts  supplied  by 
the  nerve. 

NOSTALGIA. — From  Noarico,  to  return ;  «A^o?,  suffering.  Synon.  Nos- 
tomania ;  Homesickness. — The  ungratiried  desire  to  return  home  may 
give  rise  to  symptoms  of  melancholia.  Great  bodily  and  mental  depres- 
sion. Loss  of  appetite.  Inability  to  procure  sound  sleep.  In  some  cases 
there  has  been  a  gradual  wasting,  delirium,  and  fatal  prostration.  When 
other  diseases  supervene  on  nostalgia,  the  danger  of  the  former  is 
greatlj^  increased.  Kind  treatment,  amusement,  outdoor  exercise, 
nourishing  food,  remedies  to  induce  sleep,  and  attention  to  the  secre- 
tions may  afford  relief  for  a  time.  A  temporary  return  home  often 
suffices  to  effect  a  cure. 

NYCTALOPIA. — From  Auf,  evening;  omopm,  to  see. — That  condition 
in  which  vision  is  most  powerful  during  twilight.  The  opposite  state 
to  hemeralopia. — See  Amaurosis. 

OBESITY. — From  Obesns,  flit  or  gross.  Synon.  Pohjsarcia ;  Polysar- 
cosis. — The  over-accumulation  of  fat  under  the  integuments  and  around 
some  of  the  viscera  constitutes  obesity.  Not  to  be  confounded  with 
fatty  degeneration  of  tissues.  The  term  corpulency  to  be  retained  for 
those  cases  where  the  amount  of  fat  does  not  constitute  a  disease. 

Symptoms.  Impeded  play  of  various  important  organs.  Diminution 
of  bodily  and  mental  activit}^.  Disturbances  of  organs  of  respiration, 
circulation,  and  digestion.  Panting  on  slight  exertion.  Blood  compara- 
tively deficient  in  quantity  or  quality.  Weakness  of  muscles.  Counte- 
nance bloated  and  sallow.  Liability  to  gouty  and  neui-algic  affections. 
Obesity  not  conducive  to  longevity.     Sudden  death  not  uncommon. 

Partial  obesit}^ — e.g.,  fatty  tumors,  fatty  accumulation  around  heart, 
fatty  omentum  or  "pot-belly." 

Causes.    Hereditary  tendency.    Over-feeding.    Consumj)tiou  of  large 


184  (EDEMA — (ESOPHAGEAL    STRICTURE. 

quantities  of  fluid.  Indolence,  and  too  much  sleep.  Excessive  use  of 
fatty,  farinaceous,  vegetable,  and  saccharine  foods.  Fat  is  formed  in 
the  body  from  food  containing  it ;  also  from  chemical  transformation  of 
starch  and  sugar. 

Treatment.  Rational  treatment:  Diet  of  meat,  white  fish,  green 
vegetables,  biscuit  or  dry  toast,  tea,  claret,  sheny.  Avoidance,  more  or 
less  complete,  of  bread,  butter,  milk,  sugar,  beer,  potatoes,  beans,  and 
soup.  Bromide  of  ammonium,  37.  Carbonate  of  ammonia.  Magnesia. 
Colchicum.     Exercise.     Seven  hours  for  sleep. 

Diminution  of  weight  not  to  exceed  one  pound  a  week.  General 
health,  state  of  appetite,  and  condition  of  bowels  to  be  watched. 

Remedies  formerly  employed:  Bleeding  from  the  arm,  or  jugular  vein. 
Dry  cupping.  Prolonged  blistering.  Vegetable  diet  with  vinegar. 
Acids,  except  the  nitric  and  phosphoric.  Turkish  baths.  Hot  baths. 
Salt  water  baths.  Baths  of  Aix,  Spa,  Forges,  Eouen,  and  Acqui.  Occa- 
sional starvation.  Guaiacum  and  sassafras.  Scarifications.  Grief  and 
anxiety  to  be  induced.  Purgatives.  Diuretics.  Preparations  of  iodine 
and  bromine.  Liquor  potassa?.  Fueus  vesiculosus.  Emetics.  Digitalis. 
Tobacco.     Soap.     Salt.     Mercury.     Inhalation  of  oxygen  gas. 

(EDEMA. — From  Oidicj^  to  swell.  Synon.  Hydroeedema ;  Hydroncus. — 
Dropsy  of  the  subcutaneous  areolar  tissue  of  any  one  region. 

Treatment.  Elaterium,  157.  Acid  tartrate  of  potash,  228.  Com- 
pound jalap  powder.  Compound  scammony  powder.  Acetate  of  potash. 
Digitalis  and  squills,  219.     Gin.     Acupuncture. — See  Anasarca;  Drojjsy. 

(ESOPHAGEAL  CANCER.— From  Oi<To<fdYo-,  the  swallow.  Synon. 
Cancer  of  the  Gullet. — May  occur  through  whole  length  and  circumfer- 
ence of  tube,  or  be  very  limited.  Of  scirrhous,  medullary,  or  epithelial 
variety :  latter  most  common.  Generally  fatal  within  a  year  from  com- 
mencement. 

Symptoms.  Soreness  of  throat.  Difficulty  in  swallowing.  Occasion- 
ally, cutting  pain  in  ears.  Frequent,  sometimes  constant,  sickness. 
Decided  obstruction :  after  a  time,  not  a  particle  of  food  reaches  stomach. 
Formation  of  a  pouch  above  constriction,  in  which  food  lodges.  Burning 
pain  in  canal,  back,  or  between  shoulders.  Cough,  or  hiccough.  Hemor- 
rhage.    Wasting.     Debility.     Cancerous  cachexia. 

Treatment.  Opium,  or  morphia,  315,  317.  Opium  by  rectum,  339, 
340.  Subcutaneous  injection  of  morphia,  314.  Nutrient  enemata,  21, 
23,  23.  Sometimes,  a  large  gum  elastic  catheter  (No.  14)  may  be  passed 
through  contracted  (^esophagus  and  left  in  :  so  that  cream,  solution  of 
raw  beef,  wine  and  opium  may  be  injected  through  it  every  four  or  six 
hours.     Ice,  to  relieve  thirst.     Iced  milk. 

(ESOPHAGEAL  STRICTURE.— From  Olffofdyoq,  the  swalloAV.— Stric- 
ture of  the  gullet  may  be  organic  or  functional  (spasmodic): 

1.  Organic  Stricture. — Generally  the  result  of  an  attempt  to  swallow 
some  corrosive  ])oi80n. 

Symptoms,  At  first,  vomiting.  Pain  about  oesophagus,  perhaps  dart- 
ing through  to  between  shoulders.  An  apparent  cure,  after  rest  and 
simple  diet  and  demulcent  drinks. — At  end  of  some  nine  or  twelve 
months,  great  dysphagia:  emaciation  from  inability,  which  has  been 
gradually  increasing  for  several  weeks,  to  take  solid  food. — A  gum  elastic 
catheter  can  generally  be  introduced;  through  which  solution  of  raw 
beef,  cream,  and  port  wine  can  bo  injected  into  stomach.  By  gradual 
use  of  larger  and  larger  tube,  stricture  appears  to  be  cured.     Patient  is 


(ESOPHAGISM — (ESOPHAGITIS.  185 

perhaps  removed  from  observation.  But  in  a  few  months,  all  the  s3-mp- 
toms  return:  the  wastiiiij^  and  anaemia  become  extreme:  no  instrument 
can  be  passed  down  oesophagus:  and  death  occurs  from  starvation  ia 
spite  of  nutrient  enemata. 

Treatment.  The  only  remedj'  of  any  avail,  consists  of  dilatation  by- 
frequent  use  of  bougies  for  many  months.  At  first,  a  gum  elastic  cathe- 
ter can  be  constantly  worn.  Subsequently,  a  bougie  ought  to  be  intro- 
duced at  least  twice  a  week. — In  hopeless  cases,  it  may  be  justifiable  to 
make  an  incision  through  abdominal  parietes  into  stomach  ;  forming  an 
opening  sufficiently  large  to  allow  of  daily  introduction  of  food.  Gastrot- 
omy  can  be  performed  with  knife:  or,  perhaps  better,  by  exciting 
iuflianimation,  adhesion,  and  ulceration  with  potassa  fusa. 

2.  Spasmodic  Stricture. — S^-non.  GiJsophagospasmiis ;  Tenesmus  Gulce; 
Dy.^p/uKjia  Spasinodica. — Like  the  urethra  and  bronchial  tubes,  the 
a?sophagus  may  be  affected  with  spasmodic  contraction.  Young  hys- 
terical women  subject  to  it. 

Symptoms.  Difficulty  in  swallowing.  Sense  of  fulness  and  choking 
under  influence  of  an  excitement.  Languor.  Ansemia,  &c.  Spasmodic 
cannot  be  confounded  with  permanent  stricture,  because  dysphagia  is 
only  temporary:  a  bougie  passes  with  little  or  no  difficulty:  symptoms 
aggravated  when  patient's  attention  is  directed  to  them. 

Treatment.  Ammonia  and  assafoetida,  86.  Ether  and  chloroform, 
85.  Assafoetida  and  chiretta,  89.  Valerianate  of  quinine,  414.  Vale- 
rianate of  zinc,  410.  Phosphate  of  zinc,  414.  Strj'chnia  and  steel,  408. 
Compound  iron  mixture  and  aloes,  393.  Cod-liver  oil.  Galvanism.  Cold 
shower  bath.  Nourishing  food.  Cure  of  any  general  or  uterine  disor- 
der which  ma}'  be  present. 

t 

(ESOPHAGISM. — From  O'^ixpriyix;^  the  swallow. — A  nervous  disorder, 
in  which  the  symptoms  are  allied  to  those  produced  by  spasmodic  stric- 
ture. 

Symptoms.  An  individual  fixncies  he  has  swallowed  a  pin,  or  fish 
bone,  or  other  hard  substance,  and  that  it  can  be  felt  sticking  in  the 
gullet.  Irritation  increases  as  the  delusion  is  nourished.  There  is  diffi- 
culty in  swallowing  owing  to  spasmodic  or  irregular  action  of  the  su])e- 
rior,  middle,  or  inferior  constrictor  muscle.  Even  the  medical  man  may  be 
misled  by  trusting  to  patient's  symptoms;  or  by  feeling,  with  finger  in 
throat,  upper  edge  of  cornu  of  os  hyoides,  and  mistaking  it  for  a  foreign 
body. 

Treatment.  A  careful  examination  with  finger,  bougie,  or  laryn- 
goscoj^ic  mirror  fails  to  detect  any  substance.  Galvanism.  Quinine, 
379.     Valerianate  of  zinc,  410. 

OESOPHAGITIS. — From  Olfrocpdyot;^  the  swallow  (jnw,  to  carry  ;  wdyw,  to 

eat);  terminal  -itis.  ii>y  won.  Angina  (Esophagcea ;  Dysphagia  Injiamma- 
toria ;  Inflanimatio  Gula^. — Inflammation  of  the  oesophagus  very  rarely 
a  primary-  disease.  Generally  a  result  of  strumous  diathesis;  of  one  of 
eruptive  fevers;  of  abuse  of  alcoholic  drinks,  or  irritating  drugs;  of  use 
of  acrid  poisons,  &c. — Characterized  by  dj'sphagia ;  symptomatic  fever ; 
burning  pains  shooting  from  throat  to  between  shoulders;  fits  of  cough- 
ing, hiccough  ;  constipation,  &c.  vSuppuration,  ulceration,  or  gangrene 
may  result. — Remedies  consist  of  mucilaginous  drinks;  milk  or  cream; 
aperient  enemata ;  hot  fomentations  to  throat ;  and  perfect  quiet,  even 
talking  being  forbidden. 

Simple  idceration  of  oesophagus  is  attended  with  difficult}'  in  swallow- 
ing ;  sometimes  so  great  that  deglutition  is  impossible.     Pain  at  epigas- 


186  OLIGEMIA OPHTHALMIA    TARSI. 

trinm,  or  top  of  sternum,  or  between  shoulders.  Nausea ;  anxiety ; 
emaciation  and  debility.  Ulceration  may  extend  into  trachea,  pleura, 
bronchial  tube,  pericardium,  or  aorta. — Chief  remedies : — Sponging  with 
solution  of  nitrate  of  silver  (gv.  20  to  fl.  oz.  j).  Atomized  astringent 
fluids,  262.  Bark.  Steel.  Quinine.  Cod-liver  oil.  Iodide  of  ammo- 
nium. Iodide  of  potassium.  Nourishing  food.  Sea  air.  Where  death 
is  approaching  from  starvation,  the  formation  of  agastric  fistula  should 
be  attempted. 

OLIGJEMIA. — From  ^O/.iyoq.  thin;  a\:m,  blood.  Synon.  Oligohcemia ; 
Hypcemia;  Hypohoemia. — Deficiency  of  blood. — See  Ancemia. 

ONYCHIA.  —  From  "Ow?,  a  nail.  Synon.  Paronychia;  Onychitis; 
Onychia  JIaligna. — An  inflammation  of  the  matrix  of  the  nail.  May 
arise  from  mechanical  injury;  or  from  depraved  state  of  constitution. 

Symptoms.  Pain  and  swelling  at  root  of  nail,  and  about  surrounding 
textures.  Exudation  of  sanious  discharge  on  pressure  of  nail.  Xail 
gets  raised,  and  finally  detached,  exposing  a  foul  ulcer.  Ulcer  becomes 
glazed  and  irritable  :  perhaps  extends  in  all  directions.  Occasionally, 
necrosis  of  distal  phalanx. 

Treatment.  Eemoval  of  nail.  Ulcer  to  be  dressed  with  zinc  lotion, 
264.  Nitrate  of  silver.  Local  fumigation  with  calomel.  Arsenic, 
chlorate  of  potash,  and  bark,  402.  Quinine  and  steel,  380.  Cod-liver 
oil.  Nourishing  food. — In  syphilitic  onychia, — Red  iodide  of  mercury, 
54.  Mercurial  vapor  bath,  131.  Solution  of  corrosive  sublimate,  27. 
Iodide  of  potassium,  31. 

ONYXIS. — From  "Ovu|,  a  nail  or  hoof.  Synon,  Aduncatio  Unguium  ; 
In-groaing  of  the  Nail. — Inflammation  and  ulceration  of  side  of  toe, 
owing  to  margin  of  nail  being  pressed  into  the  flesh.  Ulcer  gets  cov- 
ered with  flabby  and  sensitive  granulations.  Causes  great  sufi'ering, 
especially  during  walking. 

'  Treatment.  Removal  of  pressure  of  boot.  Nails  to  be  ordinaril}- 
cut  off' square,  instead  of  down  inner  and  outer  sides.  Scraping  side  of 
nail  very  thin,  soaking  in  hot  water,  and  introduction  of  pellet  of  cotton- 
wool so  as  to  separate  nail  from  ulcer.  Removal  of  off'ending  half  of  nail : 
anai'sthesia.  or  ether  spray.  Subsequent  dressing  with  zinc  lotion,  264. 
Excision  of  bulbiform  enlargement  close  to  edge  of  nail,  leaving  a 
sloping  surface  with  the  nail  overhanging  raw  surface. 

OPHTHALMIA. — From  "OipOakiibq,  the  eye. — A  general  term  for  in- 
flauunalion  of  the  eye. — See  Conjunctivitis ;  Sclerotitis^  &e. 

OPHTHALMIA  TARSI.— From  l)<p0aAfid^.  the  eye ;  Tapffd:;.  a  hurdle. 
Synon.  BIcjj/iiirnji/it/ialmia  ;  Blepharotitis ;  Adenophthalmia. — Inflamma- 
tion of  the  palpel)ral  conjunctiva  and  edge  of  eyelids;  with  formation 
of  minute  pustules  at  roots  of  eyelashes,  the  discharge  from  which  pro- 
duces small  crusts  matting  the  hairs  together.  When  attended  with 
much  irritation  it  is  sometimes  termed  Tinea  ciliaris,  or  tinea  pjalpebra- 
rurn,  or  psorophthabnia. 

Sympto:ms.  When  acute,  considerable  pain  and  soreness.  Usually 
chronic:  Itching;  destruction  of  tissues  wliich  secrete  the  hairs;  a 
blending  of  the  skin  and  conjunctiva  into  a  red  shining  cicatrix.  Ob- 
literation of  puncta,  causing  stillicidinm  lachrymarum. — See  Epiphora. 

Treatment.  Internally:  Improvement  of  general  health.  Tonics. 
Alteratives.  Arsenic  and  steel.  Cod-liver  oil.  Animal  food:  milk. 
Change  of  air. — Locally  :  Great  cleanliness  to  prevent  accumulation  of 


ORCHITIS — OSTEOMYELITIS.  187 

crusts.  Eyelashes  to  be  cut  off  close.  Ointments,  pro])e?-ly  (liiiited,  of 
nitrate  of  mercur}^,  red  oxide  of  mercury,  or  of  oxide  of  zinc.  Diluted 
solution  of  subacetate  of  lead.  In  obliteration  of  the  lower  puiictuni, 
the  whole  course  of  the  canaliculus  to  be  slit  up  to  the  caruncle,  so  as 
to  lay  open  the  canal  and  extend  its  orifice  backwards  to  the  point 
where  the  tears  accumulate  (Bowman). 

OECHITIS. — From  'VV/y;;^;?,  a  testicle;  terminal  -itis.  Sj'non.  Hernia 
Huinoralis. — Inflammation  of  the  testicle. — See  Testitis. 

ORTHOPNEA.  —  From  'OpOo-,  erect;  -v/co,  to  breathe.  —  Excessive 
difficulty  of  brcuthins^,  so  that  the  sufferer  has  to  maintain  erect  posi- 
tion. Often  present  in  asthma,  bronchitis,  pneumonia,  drops}-,  valvuhtr 
affections  of  the  heart,  paralytic  diseases,  &c. 

OSTEITIS. — From  'Offzkov,  a  bone;  terminal  -itis.  Synon.  Ostitis. — 
Inflammation  of  bone  arises  from  same  causes  as  periostitis.  Where 
the  latter  is  of  long  duration,  the  former  arises. 

Symptoms.  Great  tenderness.  Deep-seated  pain,  aggravated  at  night ; 
influenced  also  by  weather.     Enlargement  of  affected  bone. 

Treatment.  See  Periostitis. — Where  suppuration  occurs,  and  the 
medullary  canal  and  cancellous  structure  get  filled  with  pus,  tonics  and 
free  su])]»ly  of  nourishment  required.  Amputation  sometimes  necessaiy. 
See  Osteomyelitis. — In  circumscribed  abscesses  of  cancellated  structure 
of  either  extremity  of  tibia,  trephining  the  bone  must  be  resorted  to,  so 
as  to  let  out  the  pus. 

OSTEOID  CANCER.  —  From  Wffziov,  a  bone. — These  cancers  usuallj^ 
grow  fi-nm  some  bone,  and  especially  from  the  lower  part  of  femur. 
Their  general  history  corresponds  to  that  of  the  scirrhous  and  medullary 
varieties.  The}'  are  as  malignant  and  as  quickly  fatal  as  the  medullar}', 
and  they  give  rise  to  secondary  deposits  in  areolar  tissue/»  lymphatics, 
lunirs,  &c. — See  Cancer. 


'b^i 


OSTEOMALACIA. — From  ^Ouriov,  a  bone;  iJ.a)My.u<;,  soft.  Synon.  2fol- 
lities  0-<sii(m;  Malacosteon ;  Rachitis  Adultonim ;  Softening  of  the  Bones. 
The  characteristic  feature  of  this  disease,  as  of  rickets,  is  a  deficiency 
of  phosphate  of  lime;  so  that  the  bones  become  soft  and  unnaturally 
flexible.  The  affection  is  constitutional  :  the  whole  skeleton  is  usually 
affected,  producing  distressing  and  remarkable  deformity.  Women  be- 
yond the  age  of  forty  are  most  obnoxious  to  it :  the  pelvis  often  first 
attacked  in  childbearing  women.  Large  quantities  of  earthy  salts  are 
passed  in  the  urine.  The  general  health  becomes  hopelessly  impaired: 
gradual  loss  of  flesh  and  strength.  Severe  and  intractable  pains  of  a 
rheumatic  character:  spontaneous  fractures.  Sooner  or  later,  in  spite 
of  tonics  and  opiates  and  nourishing  food,  death. 

OSTEOMYELITIS.— From  VVr^«i/,  a  bone;  iwikoq,  marrow;  terminal 
-itis.  Synon.  Medullitis ;  Endosteitis. — Inflammation  of  the  medullary 
membrane  lining  the  central  canals  of  long  bones,  as  well  as  the  cells 
of  the  flat  and  irregular  bones;  which  delicate  vascular  membrane  se- 
cretes the  medulla,  and  is  continued  into  the  cells  of  the  cancelli  and 
the  Haversian  canals. 

Generally  the  result  of  injury:  a  frequent  cause  of  death  after  am- 
putation and  other  operations  on  bone.  The  symptoms  ai'e  usually  ob- 
scure, being  masked  by  accompanying  inflammation  and  su])pui"ation 
of  soft  parts.     It  causes  the  periosteum  to  recede  or  separate  from  sur- 


188  OTALGIA — OTITIS. 

face  of  the  bone.    But  little  modified  by  medicines  :  amputation  of  limb, 
or  of  remainder  of  limb,  often  necessary, — See  Osteitis. 

OTALGIA. — From  Oo^,  the  ear;  aXyo^,  pain.  Synon.  Otodyne ;  Ear- 
ache.— May  be  symptomatic  of  inflammation  of  ear,  or  of  presence  of  for- 
eign bodies  in  external  meatus,  or  of  tonsillitis,  or  of  disorder  of  primae 
viffi,  or  of  rheumatism  of  the  head,  kc;  or  it  may  be  idiopathic, — true 
neuralgia  of  auditory  nerves.  In  latter  case,  suffering  most  severe  on 
invasion  ;  unlike  the  pain  in  otitis,  it  does  not  increase  in  severity,  is 
unattended  by  fever,  and  often  disappears  suddenly.  Nervous  otalgia 
may  be  connected  with  imperfect  performance  of  functions  of  stomach 
or  liver;  or  may  arise  from  uterine  derangement;  or  may  occur  in  eai"ly 
stage  of  utero-gestation ;  or  may  be  due  to  a  carious  tooth;  or  perhaps 
alternates  with  sciatica,  tic  douloureux,  &c.  Sometimes  pain  very  severe ; 
it  frequently  shoots  through  nervous  filaments  distributed  over  same 
side  of  face  and  head,  causing  much  siiftering  and  restlessness. 

Treatment.  When  symptomatic,  attention  to  be  directed  to  primary 
disease.  When  idiopathic, — mild  purgatives;  quinine;  opium;  Indian 
hemp.  Application  of  a  small  blister  behind  affected  ear;  local  use  of 
chloroform  vapor,  aconite  liniment,  cotton-wool  saturated  with  lauda- 
num, steam  of  decoction  of  poppy-heads,  linseed  poultices,  the  boiled 
bulb  of  common  onion  or  of  garlic.  Carious  teeth  to  be  extracted  or 
stopped. 

Noises  in  the  ears  (tinnitus  aurium),  deafness,  confusion  in  the  head, 
&c.,  may  arise  from  accumulation  of  cerumen  in  external  meatus.  The 
wax  to  be  removed  by  thoroughly  syringing  with  warm  water;  or  with 
solution  of  carbonate  of  potash  (gr.  10  to  fl.  oz  j).  Avoid  mistaking 
deafness  and  singing  in  the  ears,  owing  to  the  pressure  of  a  mass  of  hard 
wax  on  the  membi'ane  of  the  tympanum,  for  symptoms  of  incipient 
cerebral  disease. 

OTITIS.— From  Oo:;,  the  ear  ;  terminal  -iti,s.  vS3'non.  Injlammatio  Auris; 
Inflammation  of  the  Ear. — Various  parts  of  the  organ  of  hearing  may  be 
attacked  : 

1.  Inflammation  of  External  Meatus. — Synon.  External  Otitis;  Otitis 
Catarrhalis. — The  sensitive  dermis  of  the  canal  may  become  inflamed 
from  introduction  of  irritating  matters,  an  accumulation  of  bard  wax, 
blows  on  side  of  head,  cold,  gouty  state  of  system,  impoverished  blood,  etc. 

Symptoms.  Dull  aching  pain,  increased  on  moving  jaw.  Vascularity 
and  tumefaction,  the  latter  sometimes  closing  canal  and  causing  tem- 
porary deafness.  Swelling  of  cervical  glands  on  affected  side.  In  a 
day  or  two,  a  copious  secretion  of  mucus, — often  very  thin  and  abun- 
dant. In  chronic  cases,  persistent  otorrhoea:  the  dermis  remains  more 
or  less  tumid;  epithelium  thrown  off  in  scales  which  accumulate  and 
obstruct  canal;  diminished  powder  of  hearing;  great  itching;  and  gen- 
eral de])ression. 

A  small  circumscribed  abscess  in  the  meatus  will  cause  acute  throb- 
bing pain  ;  narrowing  of  aperture  of  canal;  dulness  of  hearing.  Often 
occurs  where  there  is  a  tendency  to  boils  or  styes. 

Treatment.  The  general  health  to  be  improved.  Nourishing  food, 
witii  ])lenty  of  milk,  when  digestion  is  good.  Quinine.  Iron.  Chlorate 
of  ]jotasb.  Colchicum?  Cod-liver  oil.  Sea  air. — Locally:  Fomenta- 
tions and  poultices  ;  tVequent  bathing  to  remove  the  irritating  discharge. 
If  much  pain  and  swelling,  a  couple  of  leeches  to  margin  of  meatus  will 
relieve  congestion.  When  inflammatory  symptoms  terminate  in  chronic 
irritation,  the  collection  of  epidermis  must  be  removed  hj  syringing 


OTITIS.  189 

with  warm  water;  mild  asti'iiigent  injections  generally  useful ;  glyce- 
rine, or  olive  oil.     Sometimes  the  cure  is  hastened  by  application  of 

small  Misters  over  mastoid  process. 

2.  Inflammation  of  Membrana  Tympani. — S^-non.  Mi/n'ngifis. — May  be 
acute  or  chronic.  The  consequence  of  cold;  of  irritating  matters;  of 
gouty,  tubercular,  or  syphilitic  taints;  of  the  extension  of  disease  from 
walls  of  meatus. 

Symptoms.  Pain,  itching,  slight  deafness.  A  sense  of  discomfort  on 
affected  side  of  head.  On  examination  with  speculum,  the  membrana 
seen  to  be  opaque,  and  traversed  by  distended  vessels.  Ulceration  may 
take  place,  and  even  lead  to  perforation.  Another  result  to  be  feared 
is  permanent  relaxation  of  the  membrane  ;  which  loses  its  natural  de- 
gree of  resiliency,  becomes  flaccid,  and  falls  in  towards  the  promontor3\ 
A  third  consequence  is  thickening  and  hypertrophy  of  the  fibrous 
lamina?. 

Treatment.  When  due  to  gouty,  strumous,  or  syphilitic  taints,  the 
appropriate  remedies  for  these  conditions  are  needed.  In  other  re- 
spects, the  treatment  is  the  same  as  tor  inflammation  of  external  meatus. 
Where  there  is  perforation,  the  artificial  membrana  tympani, — a  thin 
circular  plate  of  gutta  percha  with  a  silver  wire  handle;  or  a  layer  of 
moistened  cotton-wool  with  a  thread  attached  to  it. 

3.  Inflammation  of  Tympanic  Cavity. — Sjmon.  Tnttrnal  Otitis. — A  severe 
disease.  Eendered  more  serious  by  usually  being  combined  with  inflam- 
mation of  the  internal  coat  of  the  membrana  t3Miipani. 

May  arise  from  cold,  the  poison  of  rheumatism  or  gout,  scarlet  fever, 
and  tlie  strumous  constitution.  Not  uncommon  in  3'outh  :  many  cases 
of  children's  earache,  causing  miserable  nights,  really  due  to  it. 

Symptoms.  Uneasiness  in  ear  on  blowing  nose  or  on  swallowing:  in 
a  short  time  the  discomfort  becomes  continuous.  There  ma}'  be  violent 
headache;  followed  by  intense  and  sharp  and  gradually  increasing  pain 
in  ear,  with  loud  or  beating  noises.  Then,  a  sense  of  bursting  or  disten- 
sion in  ear:  more  or  less  deafness.  Eyes  become  injected  ;  countenance 
anxious;  skin  hot;  pulse  frequent;  functions  of  kidneys  and  bowels 
disordered.  Delirium  often  present;  or,  in  children,  convuhions.  Al- 
wa3's  great  depression:  foreboding  of  some  heavy  calamity.  Facial 
paralysis  (caused  by  inflammation  extending  to  bony  canal  in  which 
portio  dura  passes  round  t^'mpanum)  imxy  occur:  power  regained  as 
morbid  action  subsides.  Termination  in  one  of  three  ways:  either  by 
resolution  ;  b}'  suppuration,  the  pent-up  pus  bursting  through  membrana 
tympani,  and  so  discharging  itself;  or  by  inflammatc^r}'  ])rocess  spread- 
ing through  mastoid  cells  internall}',  or  by  bon}'  meatus  to  periosteum 
covering  mastoid  process  externally. 

In  external  otitis,  perforation  of  membrana  tympani  may  take  place 
owing  to  extension  of  ulceration  from  without  inwards.  In  present 
case,  the  reverse  happens ;  morbid  action  progresses  from  within  out- 
wards. This  latter  the  most  frequent  cause  of  formation  of  an  orifice; 
fortunatel}'  the  opening  generally  closes  spontaneously  in  the  course  of 
a  week  or  two. 

Treatment.  To  be  conducted  with  caution.  Bowels  should  be  mod- 
erately acted  upon;  action  of  skin  promoted;  patient  kept  in  bed  in  a 
quiet  room. 

Salines,  ;-')48.  Eefrigerating  drinks,  355,  356.  Chlorate  of  potash, 
360.  Where  there  are  manifestations  of  rheumatism  or  gout,  iodide  of 
potassium  and  colchicum,  31.  Opium  or  morphia,  315,  317.  Aconite, 
330,331. — Locally:  Vapor  of  boiling  water.  Fomentations  with  poppy- 
heads,  chamomile  flowers.     Linseed,  onion,  or  garlic  j^oultices.     Small 


190  OTORRHCEA — OTORRHAGIA. 

blisters  to  mastoid  process.  When  abnormal  aperture  in  membrana 
tympani  fails  to  close,  attempts  to  be  made  to  induce  cicatrization  by 
occasional  use  of  nitrate  of  silver.  This  failing,  and  opening  being  of 
such  a  size  as  to  cause  deafness,  application  of  ai'titicial  membrane,  after 
producing  healthy  state  of  lining  tissues  of  tympanum  by  mild  astrin- 
gent lotions  and  gentle  syringing. 

OTORRH(EA.— From  0Z-,  cbrdq,  the  ear;  /5i(v,  to  flow.  Synon.  Otir- 
r/iiea;  Bleniiotorrhoea ;  Catarrh  of  the  Ear. — A  purulent  or  muco-purulent 
discharge  from  the  ear.  A  symptom  of  certain  diseases  of  the  ear;  as 
of  catarrhal  inflammation,  pol^'pus,  granulations  on  the  surface  of  the 
membrana  tympani,  &c.  Occui-s  very  frequently,  without  any  appre- 
ciable cause,  in  j^oung  children  about  the  time  of  dentition  ;  or  on  the 
subsidence  of  any  of  the  exanthemata,  especially  in  strumous  subjects. 
In  adults  it  occasionally  seems  to  be  due  to  a  depressed  condition  of 
system.  The  secretion  is  generally  ofl'ensive  and  irritating;  when  it  has 
existed  for  any  length  of  time,  it  is  often  tinged  with  blood. 

Symptoms.  Commonly  the  discharge  ceases  in  a  short  period.  Occa- 
sionally it  becomes  chronic,  and  when  this  happens  it  may  continue  for 
years;  desti'oying  in  the  course  of  time  the  membrana  tympani,  the 
ossicula  auditus,  and  producing  caries  of  the  bony  walls  of  the  meatus 
and  tympanum.  The  disease  may  even  extend  to  the  cells  of  the  mas- 
toid process  of  the  temporal  bone  ;  or  in  the  opposite  direction  along 
the  petrous  portion  of  the  same  bone,  until  the  brain  and  its  membranes 
become  involved  in  the  unhealthy  action.  This  event  indicated  by 
rigors,  fever,  and  marked  cerebral  symptoms:  ultimately  convulsions, 
coma,  and  death.  Cases  of  phlebitis,  with  pleurisy  and  pneumonia, 
have  also  resulted  from  caries  of  the  mastoid  cells. 

Treatment.  Syringing  gently  with  warm  soap  and  water;  then 
careful  examination  of  meatus  auditorius  externus  with  ear  speculum. 
If  no  cause  (as  polypus,  &e.)  be  found,  attention  to  general  health. 
Nourishing  diet, — animal  food,  milk,  &c.  Quinine  and  steel,  380.  Steel 
and  ]>epsine,  394.  Phosphate  of  iron,  405.  Mineral  acids  and  bark,  376. 
Iodide  of  iron.  32,  882.  Iodide  of  potassium  and  guaiacum  or  sarsa- 
parilla,  31.  Cod-liver  oil. — Locally:  Frequent  syringing  with  warm 
water.  Injections  of  alum,  zinc,  sulphate  of  cadmium,  or  tannin,  of 
san\e  strength  as  collyria,  291.  Glycerine.  Olive  oil.  Painting  walls 
of  canal  with  solution  of  nitrate  of  silver — gr.  6  to  fl.  oz.  j.  Equal  parts 
of  balsam  of  Peru  and  ox  gall  daily  dropped  into  ear.  Ointment  of 
carbolic  acid — gr.  10  to  lard  oz.  j.  Solution  of  chlorinated  soda — min. 
XXX  to  fl.  oz.  j. 

OTORRHAGIA. — From  05?,  wrdc;,  the  ear;  pvjy^u/u, to  burst  out. — Hem- 
orrhage from  the  ears  arises  from  different  causes:  (1)  Fracture  of 
base  of  skull,  by  which  a  communication  is  established  between  sinuses 
of  dura  mater  and  middle  ear.  The  membi'ana  tympani  being  ru])tured, 
blood  escapes  externally.  If  both  petrous  bones  be  injured,  hemorrhage 
from  both  ears.  Occurrence  of  bleeding,  on  one  or  both  sides,  generally 
regarded  as  of  unfavorable  import. — (2)  Wounds  and  ulcerations  of  audi- 
tory canal ;  whether  produced  by  earpicks  or  other  instruments,  insects, 
foreign  bodies  voluntarily  introduced,  or  old  hardened  ceruminous  con- 
cretions. To  be  stop])ed  by  extraction  of  foreign  body. — (3)  Granula- 
tions, polypi,  and  abscesses  of  auditory  canal.  To  be  cured  by  removal  of 
polypus,  use  of  nitrate  of  silver  to  granulations,  or  incision  into  ab- 
scess.— (4)  Caries  and  necrosis  of  petrous  portion  of  temporal  bone,  with  de- 
struction of  membra 7m  tympani.  If  walls  of  carotid  canal  be  involved,  a 
spiculum  of  bone  will  possibly  wound  inter)ial  carotid  artery,  and  cause 


OVARIAN    DISPLACEMENTS OVARIAN    TUMOR.  191 

fatal  loss  of  blood.  Ligature  of  common  carotid  may  have  to  l)e  re- 
sorted to. — (5)  Rupture  of  membrana  tympani ;  which  may  occur  dni-ing 
ascent  of  high  mountains,  or  in  descent  of  low  valleys,  or  in  going  to 
any  great  depth  in  a  diving-bell,  &c. ;  during  violent  sneezing  or  vomit- 
ing; or  during  paroxysms  of  whoo])ing-cough  or  asthma.  The  air  is 
violently  forced  through  Eustachian  tube  into  tympanum,  the  delicate 
meml)rane  of  which  gives  way  where  it  is  least  cai)able  of  oifei-ing  re- 
sistance— near  insertion  of  handle  of  malleus.  The  blee<iing  to  be 
checked  by  swal)bing  meatus  with  styi)tics.  Subsequently,  an  artificial 
tympanum  may  be  needed  to  relieve  deafness. — And  (6)  It  may  be  a  vi- 
carious hemorrhage, — i.e.,  it  may  perha])S  replace  menstruation,  or  long- 
continued  bleeding  from  piles  or  old  ulcers. 

OVARIAN  DISPLACEMENTS. — One  or  both  ovaries  are  occasionally 
forced  out  of  position  by  some  uterine  or  other  tumor;  or  an  ovary  may 
escape  from  pelvis,  forming  a  true  hernia  of  this  gland.  Displacements 
of  first  class,  usually  aggravate  the  s^nnptoms  of  the  disease  causing 
them:  suffering  often  ceases,  if  tumor  increase  in  size  and  pass  upwards 
out  of  pelvic  cavity.  Those  of  second  class  may  be  congenital,  or  may 
happen  accidentally  after  puberty.  Occasionall}^,  the  ovary  forms  the 
contents  of  an  inguinal,  crural,  or  umbilical  hernia. 

OVARIAN  TUMOR. — From  Ovarium  ("Qdpcov,  a  small  egg,  dimin.  of 
wo:'),  the  ovary:  Tumor  {Tumeo,  to  be  swollen),  a  tumor.  Synon.  Ova- 
rian Dropsy ;  Cystic  Disease  of  Ovary. — Consists  of  a  conversion  of  the 
ovary,  or  parts  of  it,  into  cysts.  Three  varieties  of  cysts:  Simple  or 
unilocular:  compound,  multilocular,  or  proliferous;  and  dermoid  cysts, 
the  lining  membrane  of  which  has  the  power  of  23roducing  hair,  teeth, 
sebaceous  matter,  &c. 

Symptoms.  Very  slight  in  early  stage:  disease  generally  escapes 
detection  until  abdomen  begins  to  be  enlai"ged.  In  exceptional  cases, 
tumor  while  in  pelvic  cavity  causes  irritation  of  rectum  and  bladder: 
sense  of  weight  and  oppression  :  pain  and  numbness  down  thigh  of 
affected  side.  Backache.  Menstruation  usually  regular,  perhaps 
abundant. 

In  more  advanced  stage,  great  pain  and  tenderness:  distension  of  ab- 
domen. Disordered  menstruation,  perhaps  suppression.  Loss  of  flesh. 
Constipation.  Indigestion.  Frequent  micturition  :  urine  often  scanty. 
Loss  of  appetite.  Eestless  nights.  Dyspnea.  Diminution  of  strength. 
Abdomen  found  enlarged:  fluctuation  var3'ing  in  distinctness  according 
to  number  of  cj^sts,  their  distension,  and  capacit3\  Dulness  on  percus- 
sion. Tumor  may  cause  ascites.  (Edema  of  thighs  and  legs. — At 
length  suft'ering  greatly  augmented.  Patient's  movements  impeded 
from  bulk  of  tumor.  Miserable  nights:  attacks  of  dyspnoea  necessitate 
sitting  up  in  chair.  Considerable  cedema.  Sometimes,  suppression  of 
urine  :  ursemic  poisoning.     Fatal  prostration. 

Treatment.  Abdominal  tapping,  followed  by  well-adapted  pressure, 
and  administration  of  iodide  of  potassium,  3L  Tapping,  with  intro- 
duction ofdraiiuige  tube,  so  as  continually  to  withdraw  fluid  as  it  is  re- 
secreted.  Tapping,  followed  b}^  prolonged  adniinistration  of  chlorate 
of  potash  in  full  doses.  Tapping,  with  injection  of  iodine.  Tapping, 
with  application  of  ligature  around  pedicle.  Tapping  tln-ough  vagina. 
Abdominal  section, — ovariotomy. 

Drugs  to  produce  absorption,  worse  than  useless.  Application  of 
blisters,  leeches,  iodine  ointment,  mercurial  ointment,  stimulating  lini- 
ments, electricity,  &c.,  to  be  avoided. 


192  OVARITIS — OZ^NA. 

OVARITIS. — From  Ovarium  {'Qdpwv,  a  small  egg,  dimin.  of  mh')^  the 
ovarj;  terminal -iY?'5.  Synon.  Oophoritis;  Odritis ;  Injiammatio  Ovarii. — 
Infiunimation  of  the  ovarj'^  occurs  under  tvv^o  forms, — the  acute,  and 
subacute  or  chronic. 

1.  Acute  Ovaritis. — May  arise  from  violence,  use  of  strong  caustics  to 
labia  uteri,  dilatation  of  os  with  sponge-tents,  sudden  sup})ression  of 
menses  from  shock,  gonorrhoea,  &c.  Left  ovary  more  frequently  attacked 
than  right:  double  ovaritis  rare. 

Symptoms.  Pain  of  variable  amount:  sometimes  most  intense,  caus- 
ing paroxysms  like  labor-pains;  more  frequently  of  a  dull  aching  char- 
acter, with  occasional  sharp  lancinating  attacks.  Tenderness  about 
lower  part  of  abdomen  :  of  groin  and  inner  part  of  thigh  corresponding 
to  affected  gland.  If  morbid  action  continue,  peritoneum  gets  involved. 
Bladder  becomes  irritable:  urine  scant}-,  high-colored,  and  scalding. 
Tenesmus.  Passage  of  hardened  faeces  causes  much  suffering  by  pres- 
sure on  ovary.  Fever;  ra])id  pulse;  nausea;  restlessness;  disgust  for 
food.  On  examination,  the  swollen  and  exquisitely  sensitive  ovary 
easily  detected. — If  suppuration  occur,  there  will  be  rigors;  quick  and 
fcel)le  pulse;  glazed  red  tongue;  excessive  sickness;  sense  of  weight 
and  throbbing  about  pelvis.  Abscess  may  burst  in  peritoneum,  setting 
up  severe  peritonitis:  more  favorably,  into  rectum  or  vagina.  Sucb 
cases  sometimes  very  tedious:  opening  closes,  but  pus  accumulates 
again  and  again. 

Treatment.  Hot  hip  baths,  night  and  morning  Pessaries  of  opium 
and  belladonna,  423.  Fomentations:  hemlock  poultices:  linseed  poul- 
tices,— to  vulva,  hypogastric,  and  inguinal  regions.  Iodide  of  potassium, 
31.  Guaiacum  and  aconite,  43.  Oj)ium  and  belladonna,  344.  Eectum 
to  be  emptied  by  enemata  of  olive  oil,  188.  Leeches  to  labia  uteri,  if 
attack  be  due  to  sudden  suppression  of  menses.  If  an  abscess  point  in 
vagina,  it  may  be  cautiously  opened  with  a  trocar  or  bistoury. 

2.  Chronic  Ovaritis. — A  common  disease  during  period  of  sexual 
vigor.  Euns  a  tedious  course.  May  be  set  up  by  excessive  sexual 
intercourse;  unskilful  use  of  uterine  sound,  or  caustics;  rheumatic  and 
syphilitic  taints,  &c. 

Symptoms.  Dull  and  continuous  aching  in  ovarian  and  sacral  regions. 
Tenderness  of  upper  j^art  of  one  or  both  thighs.  Scant}'  and  dithcult 
menstruation.  Pain  on  sexual  intercourse.  Irritability  of  stomach  ; 
nausea,  indigestion,  constipation,  flatulence.  Fits  of  hysteria.  Irrita- 
bility of  bladder.  Tumefaction  and  tenderness  of  one  or  both  breasts. — 
Attacks  of  nymphomania,  or  even  some  forms  of  chronic  insanitj",  may 
arise  from  subacute  ovaritis.  Inflamed  gland  found  swollen  and  sensi- 
tive, on  making  a  vaginal  examination. 

Treatment.  Iodide  of  potassium,  31.  Bromide  of  ammonium,  37. 
Guaiacum  and  aconite,  43.  Hydrochlorate  of  ammonia,  60.  Cod-liver 
oil,  389.  Pepsine,  420.  Ammonia  and  bark,  371.  Quinine  and  bella- 
donna, 383.  Iodide  of  iron  and  cod-liver  oil,  390.  Iodide  of  lead  and 
belladonna  pessaries,  423.  Belladonna  plaster  to  sacrum.  Wai-m  hip 
baths.  Warm  clothing:  flannel  drawers.  Animal  food,  milk,  raw  eggs. 
Gentle  walking  exercise. 

Avoidance  of:  Blisters.  Leeches.  Calomel.  Antimony.  Strong  pur- 
gatives.    Sexual  intercourse. 

OZiENA. — From  "^^ij,  a  stench.  Synon.  Coryza  Virulenta ;  Pyorrhoea 
JVasalis;  liliinitis  Ulcerosa. — Chronic  inflammation  of  the  nostrils.  Due 
to  long-continued  attacks  of  catarrh,  especially  in  gouty  or  strumous  sub- 


PANCREATIC    DISEASE — PARALYSIS.  193 

jects ;  syphilitic  taint;  abscess  of  septum  ;  chronic  ulceration;  polypi; 
necrosed  bone;  or  foreign  bodies  in  nasal  cavities. 

Symptoms. — Appearance,  perhaps,  of  common  cold.  Uneasiness  and 
''stuffiness"  of  nose.  Swelling  of  pituitary  membrane.  Headache. 
Profuse,  fetid,  muco-purulent  discharge ;  sometimes  tinged  with  blood. 
Formation  of  flakes  of  fibrine  or  hardened  mucus;  which  if  allowed  to 
remain  in  nose,  decompose,  and  give  out  a  most  disgusting  odor.  Septum 
of  nose  often  eaten  through,  leaving  a  small  round  hole.  Caries  or 
necrosis  of  spongy  bones,  especially  in  s^^philitic  cases. 

Treatment.  General  remedies  :  Quinine  and  iron,  380.  IS'itro-hj-dro- 
chloric  acid,  378.  Arsenic  and  bark,  &c.,  52.  Steel  with  arsenic,  381, 
399.  Cod-liver  oil.  Chlorate  of  potash  and  steel,  402.  Iodide  of  iron 
and  cod-liver  oil,  390.  Iodide  of  potassium,  31.  Corrosive  sublimate, 
27.  Eed  iodide  of  mercury,  54,  55.  Green  iodide  of  mercury,  53.  Mer- 
curial vapor  baths,  131.     Sea  air.     Nourishing  food.     Warm  clothing. 

Locally :  Frequent  and  thorough  syringing  with  warm  water.  Injec- 
tions of  alum;  or  zinc;  or  jjcrmanganate  of  potash,  78.  Inhalation  of 
steam  medicated  with  iodine,  259;  or  creasote,  260;  or  turpentine,  260. 
Iodine  vapor,  259.  Nitrate  of  mercury  ointment,  305.  Iodide  of  lead 
ointment,  293.  Pulverized  medicated  fluids,  262.  Snuff's  of  chlorate  of 
potash  and  sugar  (gr.  30  and  oz.  ^) ;  or  of  red  oxide  of  mercury  and 
sugar  (gr.  5  and  oz.  J) ;  or  of  white  bismuth. 

PANCREATIC  DISEASE.— Disease  of  pancreas  (from  /7«v,  all;  xpiac, 
flesh)  of  comparatively  rare  occurrence.  When  affected,  it  is  mostly 
impossible  to  diagnose  exact  nature  of  morbid  state. 

Diseases  which  may  occur  are :  Congestion,  hypertTdphy,  inflamma- 
tion, suppuration,  induration,  serous  softening.  Atrophy;  fatty  degen- 
eration. Simple  C3'stic  tumors;  hydatid  tumors.  Scirrhous  or  medul- 
lary cancer.  Calculous  concretions,  composed  of  carbonate  and  phos- 
phate of  lime  cemented  by  animal  matter,  are  not  uncommonly  found 
in  pancreatic  duct  or  its  branches  :  of  a  white  color,  varying  from  size 
of  a  pea  to  that  of  a  walnut,  and  existing  singly  or  to  the  number  of  flf- 
teen  or  twenty. 

Symptoms.  Most  jiancreatic  disorders  attended  by  enlargement  and 
tenderness  of  gland.  Epigastric  tenderness  ;  fulness  or  hardness  ;  sense 
of  heat  and  constriction.  Nausea  and  vomiting;  salivation  ;  loss  of  ap- 
petite; inodorous  eructations.  Fatty  stools.  Mental  depression.  De- 
bility, with  emaciation.  If  common  choledic  duct  be  pressed  upon  by 
pancreatic  tumor,  or  if  it  be  involved  in  structural  disease  of  gland, 
there  will  be  persistent  jaundice. 

Treatment.  Alleviation  of  prominent  symptoms.  Pancreatic  emul- 
sion. In  obstinate  sicknesitf, — nutrient  enemata.  Ice.  Seton  in  abdomi- 
nal wall  over  seat  of  gland.     Eepeated  small  blisters. 

PARALYSIS. — From  flapakuo),  to  relax  —  to  aff'ect  with  paralysis. 
Synou.  Paresis;  Palsy. — A  total  or  partial  loss  of  sensibilit}^  or  motion, 
or  of  both,  in  one  or  more  parts  of  body.  Two  great  classes  of  par- 
alytic aff'ections  :  (1)  Perfect  paralysis,  in  which  both  motion  and  sensi- 
bility are  affected.  (2)  Imperfect,  in  which  onlj"  one  or  the  other  is  lost 
or  diminished.  Divided  into  acinesia  ('J,  priv. ;  xv^-qa'.:;,  motion),  paralysis 
of  motion  ;  and  ancesthesia  CA,  priv.;  alaOdvoixm,  to  feel),  paralysis  of  sen- 
sibility.— Again,  palsy  may  be  general,  when  it  affects  whole  body; 
or  partial  when  confined  to  one  portion,  —  hemiplegia  or  paraplegia. 
Term  local  palsy  used,  when  only  a  small  portion  of  body  is  affected; 
as  face,  a  limb,  one  foot.  In  reflex  paralysis  (Keflecto,  to  turn  back)  the 
irritation  extends  from  perij^hery  to  centre  :  diseases  of  urinary  organs, 

13 


194  PARALYSIS. 

uterus,  and  intestines  most  common  causes  of  this  foi-m.  A  peculiar  dis- 
ease known  as  wasting  palsy,  prominent  symptom  of  which  is  a  degenera- 
tion and  wasting  of  the  muscles. 

Palsy  may  he  due  to  disease  of  brain  arising  from  apoplexy',  abscess, 
softening,  induration,  tubercular  or  cancerous  tumors,  renal  disease, 
epilepsy,  chorea,  or  poison  of  syphilis;  to  disease  of  spinal  cord,  as  in- 
flammation, atrophy,  solution  of  continuity,  &c. ;  to  diseases  of  invest- 
ing parts  of  brain  or  cord,  acting  by  pressure  ;  to  lesion  or  compres- 
sion of  a  nerve,  by  which  its  conducting  power  is  impaired;  to  some 
affection  of  the  muscle  itself,  as  is  possibly  seen  in  wasting  palsy;  to 
hysteria,  or  to  rheumatism;  and  to  influence  of  such  poisons  as  lead, 
mercuiy,  &c. 

1.  General  Paralysis. — Complete  loss  of  sensation  and  motion  of  whole 
system  cannot  take  place  without  immediate  death.  Term  "general 
paral3'si8"  usually  applied  to  palsy  affecting  the  four  extremities,  whe- 
ther any  other  parts  of  body  are  affected  or  not.  Must  not  be  con- 
founded with  progressive  paralysis  of  insane:  see  Insanity. 

A  case  has  been  related  in  which  power  of  motion  in  every  part  of 
body  was  lost,  save  in  muscular  apparatus  of  tongue,  and  of  organs  of 
deglutition  and  respiration.  Sensibility  also  wholly  destroyed  except 
in  a  small  patch  on  right  cheek,  by  tracing  letters  on  which  the  patient 
could  be  communicated  with  (Defei*mon). 

2.  Hemiplegia. — From  "///^j^y?,  half ;  7:).rjaff(o.  to  strike.  Synon.  Hemi- 
plegia.— Paralysis  of  one  side,  almost  invariably  involving  both  upper 
and  lower  extremity.  Most  common  form  of  palsy.  Usually  spoken 
of  as  ''a  paralytic  stroke."  Left  more  frequently  affected  than  right 
side.  If  onl}-  one  extremity  suffer,  it  is  generally  the  arm.  Yery  rarely, 
upper  limb  of  one  side  and  lower  of  opposite  are  paralyzed, — transverse 
or  crossed  palsy. 

Symptoms.  Facial  nerve  or  poi'tio  dura  of  seventh  pair  seldom  in- 
volved. Fifth  nerve  aftected ;  so  that  palsied  cheek  drops  loosely, 
while  mouth  is  drawn  upwards  to  sound  side  by  non-counteraction  of 
paralyzed  muscles.  Tongue  implicated  ;  when  protruded,  point  turned 
to  diseased  side,  owing  to  vigorous  action  of  healthy  muscles  pushing 
sound  half  further  out  than  the  other.  Articulation  imperfect  owing 
to  palsy  of  ninth  and  fifth  nerves.  If  third  nerve  be  involved, — drop- 
ping of  upper  eyelid,  dilated  pupil,  divergent  squint. — Often  anesthesia. 
Mental  faculties  frequently  damaged.  Tendenc}'  to  shed  tears.  For- 
getfulness  and  misi)lacement  of  words.  In  red  softening  of  bi"ain, 
muscles  of  one  of  atfected  limbs  often  rigid  and  contracted. — In  hope- 
less cases,  limbs  waste:  muscles  atrophy,  owing  to  diminution  of  nu- 
trition. Prognosis  unfavorable  if  there  be  flexion  of  fingers  into  palms 
of  hands.  In  favorable  instances,  symptoms  of  amendment  first  observed 
in  leg.  Where  the  arm  regains  power  before  the  leg,  prognosis  un- 
favorable. 

Treatment.  Depletion  injurious.  Cathartics  sometimes  useful  at 
first:  Scammony  and  jalap;  calomel;  crotonoil;  stimulating  purgative 
enemata.     Efficacy  doubtful  of  blisters  to  scalp  or  nucha,  or  of  setons. 

When  muscles  of  palsied  limb  are  perfectly  flaccid,  the  lesion  is  prob- 
abl}"  owing  to  white  softening  from  defective  nutrition.  Hence,  wine 
and  nourishment  to  be  given;  cod-liver  oil;  ammonia  and  bark;  am- 
moniocitrate  of  iron  ;  h3'pophospiiite  of  soda  or  lime. — When  muscles  are 
contracted  or  resist  movement,  the  lesion  of  an  irritative  kind  ;  perhaps 
an  ajjoplectic  clot  which  has  lacerated  nerve  fibres.  In  such,  mild  pur- 
gatives; blisters;  sulphur  baths;  iodide  of  potassium. — In  reflex  hemi- 
plegia, removal  of  the  cause. 


PARALYSIS.  195 

In  chronic  forms:  Small  doses  of  strycliniji,  wlici'c  there  is  no  active 
disease  of  brain.  Mild  foi'riiginous  tonics  :  phosjiliate  of  ii'on  ;  aninionio- 
citrate  of  ii'on.  Cod-liver  oil.  Animal  food;  milk.  Frictions  of  limbs 
and  spine  with  flesh-brush;  liniments  of  turpentine,  cantharides,  am- 
monia, kv.  P^lectricity  and  galvanism,  when  paralysis  remains  without 
muscular  rigidity. 

3.  Paraplegia.  —  From  Haf^a-Xri^ia,  partial  paralysis, — TzapaTzXTjatrto,  to 
strike  badly.  S^^non.  Rachioplegia ;  Myelopnralyais ;  Paralysis  Spinalis. 
— Palsy  of  the  lower  half  of  body.  Two  varieties:  (1)  that  due  to  dis- 
ease of  spinal  cord  or  membranes.  (2)  Reflex  paraplegia,  that  caused 
by  excitation  which  has  reached  the  cord  from  a  sensitive  nerve.  There 
is  probabl}"  an  insufficient  amount  of  blood  in  cord. 

Symptoms.  Begin  slowly  and  insidiously.  Weakness  and  numbness 
and  tingling  of  feet  and  legs.  AYeakness  increases,  until  there  is  com- 
plete loss  of  sensibility  and  motion  in  lower  extremities.  Paralj'sis  of 
bladder  and  sphincter  ani.  Decomposition  of  urine  in  bladder.  Invol- 
untary movements  and  spasms  of  legs  often  very  distressing.  Reflex 
movements  excited  more  easily  in  paraplegia  than  in  hemiplegia. 
Marked  deterioration  of  general  health. 

Treatment.  An  important  distinction  to  be  drawn  between  cases 
where  there  is  congestion  or  inflammation  of  spinal  cord  or  membranes, 
and  the  opposite  condition. 

(1)  Where  amount  of  blood  is  increased,  as  in  chronic  local  myelitis, 
there  ai'e  symptoms  of  irritation  of  motor  nerve-fibres, — as  convulsions, 
cramps,  twitchings,  priapism;  with  indications  of  irritation  of  sensitive 
nerve-fibres, — as  itcliing,  pricking  pains,  abnormal  sensations  of  cold  or 
heat,  &c. ;  and  also  signals  of  irritation  of  vaso-motor  or  nutritive  nerve- 
fibres,  as  wasting  of  muscles,  bed-sores,  alkaline  urine,  &c.  Pain  corres- 
ponding to  upper  limit  of  inflammation.  Tenderness  on  pressure.  Ap- 
plication of  a  hot  sponge  causes  sense  of  heat  in  all  parts  above  inflam- 
mation, with  burning  sensation  at  upper  limit.  Application  of  a  piece 
of  ice  over  vertebrae  gives  rise  to  sense  of  cold  everywhere  except  at 
level  of  inflammation,  w^here  feeling  of  heat  is  experienced.  In  treating 
these  cases,  quantity  of  blood  sent  to  cord  is  to  be  diminished.  Ergot 
of  rye,  in  five  or  six  grain  doses,  twice  daily.  Belladonna.  Belladonna 
plaster  over  spine.  Iodide  of  potassium,  in  conjunction  with  belladonna. 
Cod-liver  oil.  Henbane,  conium,  or  Indian  hemp  to  relieve  restlessness. 
Avoidance  of  opium,  as  it  causes  congestion  of  cord.  Nutritious  diet: 
wine  or  beer,  milk.  Nutrition  of  limbs  to  be  maintained  by  shampooing, 
stimulating  liniments:  at  a  subsequent  period  by  very  gentle  galvanic 
current. 

(2)  In  paraplegia  due  to  diminished  nutrition  of  cord,  as  that  caused 
by  white  softening  and  reflex  palsy,  food  and  remedies  needed  to  im- 
prove quality  of  blood,  and  cause  an  increased  quantity  to  be  sent  to 
cord.  Strychnia,  gr.  ^'^  dail}^.  Opium.  Quinine  and  iron.  Nitrate  of 
silver  and  hypophosphite  of  soda,  419,  deserving  of  trial.  Cod-liver  oil. 
Sulphur  baths.  Very  nourishing  food.  Patient  to  lie  on  his  back,  with 
head  and  shoulders  and  lower  extremities  raised,  so  that  blood  may 
gravitate  to  coi'd. 

A  controlling  power  can  be  exercised  by  means  of  heat  and  cold  ap- 
plied to  different  parts  of  back,  over  the  circulation  in  brain  and  spinal 
cord  and  ganglia  of  symj^athetic,  and  through  agency  of  these  nervous 
centres  in  every  other  organ.  In  this  way,  reflex  excitability,  or  excito- 
motor  power  of  cord,  and  contractile  force  of  arteries  in  all  parts  of  body 
can  be  modified.  To  lessen  the  excito-motor  power,  ice  is  apjjlied  in  an 
India-rubber  bag  about  two  inches  wide,  over  that  part  of  spine  on 


196  PARALYSIS. 

which  it  is  wished  to  act.  On  same  principle,  vitality  of  cord  increased 
by  using  hot  water  and  ice  alternately,  each  in  an  India-rubber  bag  if 
energetic  action  be  requii-ed  :  w^here  less  vigorous  efforts  are  called  for, 
ice  or  iced  water  only  emplo^'ed,  resorting  to  application  several  times 
a  day,  for  a  short  time  on  each  occasion,  with  long  intervals  between 
(John  Chapman). 

In  reflex  paralysis,  while  relieving  loss  of  power  on  preceding  prin- 
ciples, the  external  cause  must  be  removed.  Thus,  the  practitioner 
should  expel  intestinal  worms;  laiice  gums;  relieve  irritability  of  uri- 
nary and  sexual  systems;  cure  skin  diseases,  &c. 

4.  Local  Paralysis. — Many  varieties  of  local  palsy.  Only  necessary  to 
mention  one,— Paralysis  of  face.  Eesults  from  pressure  on,  or  injury  to, 
portio  dura  or  facial  portion  of  seventh  pair  of  nerves ;  a  nerve  rarely 
affected  by  disease  of  brain.  Exposure  to  cold,  and  debility,  most  fre- 
quent causes  of  facial  palsy.  May  also  be  due  to  irritation  of  decaj-ed 
teeth.  In  children,  otitis  leading  to  caries  of  peti-ous  portion  of  tem- 
poral bone  may  produce  the  disease.  It  will  last  from  a  few  days  to 
several  weeks.     Usually  free  from  danger. 

Symptoms.  Appearance  remarkable,  as  only  one-half  of  face  is  usu- 
ally palsied.  Features  on  affected  side  blank,  unmeaning,  void  of  all 
expression.  Orbicularis  palpebrarum  muscle  powerless,  so  that  eyelids 
cannot  be  closed.  Inabilit}'  to  frown  or  blow;  nostril  does  not  dilate; 
cheek  hangs  loose;  angle  of  mouth  droops. — Fifth  i)air  of  nerves  unaf- 
fected; so  that  muscles  of  mastication  act  properly.  No  loss  of  sensi- 
bility.— In  facial  parah^sis  due  to  cerebral  hemorrhage  the  symptoms 
are  less  marked,  though  of  same  character  as  foregoing. 

Paralysis  of  portio  dura  on  both  sides,  a  rare  affection.  When  it 
occurs  there  is  no  distortion  of  features  owing  to  symmetrical  nature  of 
disease.  On  close  examination,  however,  nostrils  are  found  motionless; 
cheeks  fiat  and  relaxed;  inability  to  close  eyes  completely;  defective 
articulation  with  regard  to  sounds  formed  by  lips,  but  unimpaired  lingual 
articulation. 

Treatment.  Mild  antacid  aperients.  Iodide  of  potassium.  Bi-omide 
of  potassium.  Nourishing  food.  Warm  bathing.  Friction  with  sham- 
pooing.    Galvanism. 

5.  Progressive  Locomotor  Ataxy. — From  'A,  neg.;  rdffaw,  to  put  in 
order.  Syuon.  Tdhes  Dorsal  is ;  Wasting  of  posterior  columns  of  Spinal 
Cord. — A  peculiar  form  of  paraplegia  produced  by  sexual  excesses,  ex- 
posure to  cold  and  damp,  rheumatism,  gout,  &c.  Most  common  in  males 
about  middle  period  of  life.  In  well-marked  cases  it  has  been  shown 
that  atroplij^  and  disintegration  of  nerve-fibres  of  posterior  columns  of 
spinal  cord  has  taken  place,  with  formation  of  amyloid  corpuscles  and 
hypertrophy  of  connective  tissue.  Lesions  not  always  confined  to  pos- 
terior columns  of  cord.  Often  also  a  certain  gray  degeneration  of  cere- 
bral nerves,  of  spinal  nerves,  and  various  lesions  of  gray  substance  of 
cord  (Lockhart  Clarke). 

Symptoms.  The  pathognomonic  symptom  is  a  diminution  or  total 
absence  of  power  of  co-ordinating  movements;  so  that  patient  has  dif- 
ficulty in  walking,  loses  his  balance,  and  has  an  uncertain  and  tottering 
gait.  Distinct  fi-om  ordinary  paraplegia,  in  which  there  is  impairment 
or  loss  of  voluntary  motion. 

Intellect  and  memory  unaffected.  Occasionally  more  or  less  paralysis 
of  second,  third,  fifth,  sixth,  seventh,  and  some  poi-tions  of  eighth  cere- 
bral nerves.  T^arely  deafness:  difficulty  in  swallowing:  strabismus: 
double  vision.  A  sensation  as  of  strings  tied  round  abdomen  now  and 
then  com])lainL'd  of.     Jrlheumatic  pains:  sharp  pains  over  limited  spots. 


PARALYSIS.  197 

No  tenderness  on  examination  of  spine.  "Pins  and  needles,"  with 
numbness  in  lower  extremities;  a  feeling  of  insecurity  in  walking,  so 
that  the  legs  have  to  be  watched  to  prevent  staggering,  while  they  are 
thrown  forwards  spasmodically  and  tlien  planted  forcibly  on  the  ground. 
Ultimately,  loss  of  sensation  in  lower  limbs;  complete  amaurosis;  in- 
creasing weakness,  so  that  patient  cannot  leave  his  bed.  Progress  of 
disease  slow  :  perfect  recovery  very  rare.  Occasionally  death  occurs 
from  intercurrent  affections,  as  bronchitis,  pneumonia,  erysipelas,  &c. 

Treatment.  A  nourishing  diet:  animal  food;  raw  eggs;  rum  and 
milk ;  milk  cocoa  in  place  of  tea  and  cottee.  Nitrate  of  silver,  59.  Phos- 
phate of  iron,  405.  Iodide  of  iron,  32,  390.  Quinine  and  iron,  380. 
Bark  and  phosphoric  acid.  376.  Aloes  and  pepsine,  155.  Aloes  and 
reduced  iron,  404.  Ilypophosphite  of  soda  or  lime,  419.  Belladonna. 
Indian  hemp.  Cod-liver  oil.  Sulphur  baths,  125.  Continuous  galvanic 
current  to  lower  part  of  spine.  Mineral  waters,  in  early  stage,  of  Ba- 
reges, 470;  of  Marienbad,  497;  of  Wiesbaden,  489. 

JRemedies  often  recommended  :  Iodide  of  potassium.  Ergot  of  rye.  Ar- 
senic. Bromide  of  potassium.  Nux  vomica  and  strychnia.  Opium. 
Turpentine.  Faradization.  Actual  cautery,  moxa,  blisters,  and  leeches 
to  spine. 

6.  Hysterical  and  Rheumatic  Paralysis. — In  hysterical  palsy  there  is 
neither  disease  of  nervous  centres  nor  of  motor  nerves.  Occurs  in  hys- 
terical women:  produced  by  fright,  over-excitement,  ovarian  irritation, 
&c.  Muscles  of  lower  extremities  may  be  affected  (hysterical  para- 
plegia); or  muscles  of  arm  and  leg  on  same  side  (hysterical  hemiplegia) ; 
or  only  one  or  two  particular  muscles.  Generall}",  other  symptoms  of 
hysteria  present.  May  be  cured  by  remedies  which  improve  general 
health.     Ferruginous  tonics.     Antispasmodics.     Galvanism. 

In  rheumatic  palsy  muscles  of  lower  extremities  often  attacked :  or 
extensor  muscles  of  forearm,  or  deltoid  and  trapezius  rendering  it  diffi- 
cult to  raise  arm.  May  come  on  suddenly  or  gradually.  To  be  cured 
b}'  galvanism,  shampooing,  iodide  of  j)otassium,  cod-liver  oil. 

7.  Progressive  Muscular  Atrophy. — From  M,  priv. ;  rpi^w,  to  noui-ish. 
Synon.  Wasting  Palsy ;  Creeping  Palsy ;  Idiopathic  Degeneration  of  Vol- 
untary Muscles;  Atrophie  Musculaire  avec  Transformation  Graisseuse. — 
Paralj'sis  from  a  granular  and  fatty  degeneration  of  muscular  fibre, 
owing  to  some  error  of  nutrition.  Patches  of  granular  degeneration 
have  sometimes  been  found  in  those  parts  of  gra}'  substance  of  spinal 
cord  whence  nerves  pass  off  to  affected  muscles.  Also,  amyloid  cor- 
puscles round  central  canal  of  cord.  Nerve-cells  shrunken  and  atro- 
phied. Difficult  to  say  whether  spinal  cord  lesion  is  primary  or  sec- 
ondarj'.  The  former  is  rendered  more  probable  than  was  formerly 
believed,  by  researches  of  Lockhart  Clarke. 

Symptoms.  The  pathognomonic  feature  is  a  degeneration,  and  con- 
sequent loss  of  volume  and  power,  of  voluntary  muscles;  without  dimi- 
nution of  intelligence  or  sensibility.  May  affect  upper  or  lower  limbs, 
or  voluntary  muscles  of  whole  bod}''. 

Fibrillary  tremors  or  convulsive  quiverings  of  some  of  the  fasciculi 
which  form  the  muscle;  produced  by  irritation  of  skin;  patient  uncon- 
scious of  their  occurrence.  Unwonted  lassitude  of  limbs,  slowlj'  ]')ro- 
gressing  to  marked  weakness.  A  withered  look,  owing  to  muscular 
wasting.  Occasionally,  neuralgic  or  rheumatic  pains.  Great  sensitive- 
ness to  cold.  Intellectual  powers  undisturbed.  General  health  moder- 
ately good. — As  disease  progresses,  total  deprivation  of  motion  in 
affected  limbs.  Patient  often  has  to  be  fed  and  carried  about  like  a 
child.     Power  of  deglutition,  and  articulation  may  be  lost.     Fatal  as- 


198  PARALYSIS. 

phyxia  a  common  termination, — for,  as  a  consequence  of  catarrh,  bron- 
chitis, &c.,  mucus  accumulates  in  air-tubes:  owing  to  diaphragm  and 
intercostal  muscles  being  involved,  no  etforts  at  expectoration  can  be 
made.     Occasionally,  apncea  from  paralysis  of  respiratory  muscles. 

Duration  of  disease  varies  from  a  few  months  to  some  years.  Com- 
plete recovery  rare  :  progress  of  disease  sometimes  suspended,  especially 
when  muscles  of  trunk  are  not  involved.  General  muscular  atrophy 
spares  neither  children,  adults,  nor  aged  people  :  partial  form  most  com- 
mon between  thirtieth  and  fiftieth  3'ear.  Males  suffer  more  than  fe- 
males. Exposure  to  wet  and  cold,  or  hard  work,  often  assigned  as 
causes.  May  follow  fever,  sun-stroke,  falls  and  blows,  &c.  It  is  hered- 
itary. 

Treatment.  Attention  to  digestive  organs.  Hypophosphite  of  soda 
or  lime,  419.  Nitrate  of  silvei-,  59.  Frictions  of  affected  muscles.  Sul- 
phur baths,  125.  Galvanism  to  wasting  muscles.  Localized  Faradiza- 
tion (electricity  of  induced  or  secondary  current  in  helix  round  magnet, 
discovered  b}'  Faraday);  not  giving  more  than  one  or  two  minutes  to 
each  muscle,  lest  it  get  fatigued,  and  not  prolonging  each  sitting  for 
more  than  ten  or  fifteen  minutes. 

Bemedies  ichicli  have  generally  failed:  Strychnia  and  nux  vomica. 
Mercury.  Iodide  of  yjotassium.  Tonics.  Cod-liver  oil.  Setons,  issues, 
or  blisters  over  vertebral  column.     Cold  baths  during  active  stage. 

8.  Mercurial  Palsy. — Synon.  Mercurial  Tremor. — A  convulsive  agita- 
tion of  voluntary  muscles,  increased  when  volition  is  bi-ought  to  bear 
upon  them.  In  advanced  stages,  articulation  and  mastication  and  loco- 
motion performed  with  difficulty.  Sometimes  delirium,  or  even  acute 
mania.  Use  of  hands  almost  entirely  lost.  Epilepsy.  Great  weakness. 
Eestlessness  at  nights.  Skin  acquires  a  dirty  brown  hue.  Soreness  of 
gums.  Teeth  turn  black,  decay. — The  sufferers  are  workmen  exposed 
to  fumes  of  mercur}-. — gilders  of  buttons,  glass-platers,  barometer 
makers,  &c.  Chemists  working  with  mercuric  methide  ought  to  take 
special  precautions  to  avoid  the  deadly  influence  of  this  very  poisonous 
compound. 

Treatment.  Withdrawal  entirely  from  injurious  atmosphere.  Iodide 
of  potassium,  31.  Nourishing  food.  Cod-liver  oil.  Warm  baths.  Sul- 
phur baths,  125.     Galvanism.     Sea  air. 

9.  Lead  Palsy. — Synon.  Paralysis  katurnina ;  Metallic  Palsy ;  Painter's 
Palsy. — Often  follows  or  accompanies  lead  colic,  though  it  may  exist  in- 
dependently. Operatives  in  lead-works  and  mines  suft'er  much  from 
saturnine  emanations.  Work-rooms  where  manufacture  of  white  lead 
is  completed  have  their  atmosphere  loaded  with  minute  particles  of  lead 
compounds;  so  that  workers  in  them  get  "leaded," — become  victims  of 
paralysis,  colic,  gout,  sleeplessness,  neuralgia,  spasms  of  respiratory 
muscles,  debility  and  pallor  and  emaciation,  &c.  Plumbers,  painters, 
color-grinders,  type-founders,  &c.,  also  suffer  much. 

Symptoms.  Poison  of  lead  exerts  a  peculiar  noxious  influence  over 
nerves  of  forearm  and  hand  ;  in  consequence  of  which,  extensor  mus- 
cles of  hands  and  fingers  get  paralyzed,  and  hands  hang  down  by  their 
own  weight  when  arms  are  stretched  out, — the  wrists  drop.  Inferior 
extremities  rarely  aftected.  Frequent  attacks  of  lead  colic.  Saturnine 
taste  and  odor  in  breath.  Formation  of  a  blue  or  i)urplish  line  round 
edges  of  gums,  just  where  they  join  the  teeth,  a  charaeteritstic  feature. — 
Death  may  occur  when  system  has  long  been  exposed  to  influence  of 
lead;  especially  if  health  be  also  injured  by  intemperance,  or  by  fre- 
quent attacks  of  gout. 

Treatment.     Curative:    Iodide  of  potassium,  81.     Galvanism.     Sul- 


PARAPHIMOSIS PELLAGRA.  199 

phur  baths,  125. — Prophylactic:  All  workers  in  lead  should  drink  sul- 
phuric acid  lemonade  daily.  To  avoid  intoxicating  drinks.  Functions 
of  skin  to  ho  promoted  by  cleanliness. 

10.  Paralysis  Agitans. — Synon.  Paralysis  Tremula;  Tremor;  Shaking 
Palsy. — Characterized  by  an  involuntar}-  tT'cmulous  aji^itation  of  mus- 
cles; commencing  in  hands  and  arms,  or  in  head,  and  gradually  extend- 
ing over  whole  body.  Diminished  muscular  power.  A  propensity  to 
bend  the  trunk  forwards,  and  to  pass  from  a  walking  to  a  gentle  run- 
ning pace.  Senses  and  intellect  uninjured.  Disease  progresses  slowly. 
When  far  advanced,  agitation  may  be  so  violent  as  to  prevent  sleep. 
Deglutition  and  mastication  performed  with  difficulty.  Inclination  of 
body  forwards,  with  bending  of  chin  or  sternum.  Involuntar}-  escape 
of  fffices  and  urine.     Slight  delirium  and  fatal  coma. 

Treatment.  Few  remedies  of  much  use.  The  effects  may  be  tried 
of  pure  air,  nourishing  food,  baths,  ferruginous  tonics,  cod-liver  oil,  and 
occasional  opiates.  Benefit  may  perhaps  be  obtained  from  employment 
of  continuous  galvanic  current,  such  as  can  be  derived  from  a  Pulver- 
macher's  chain-battery  of  120  links. 

PARAPHIMOSIS.— From  Ilapa,  beyond;  fi/idoj,  to  bind  tight.  Synon. 
Phi/iwsis  Circitmligata. — That  condition  in  which  a  tight  prepuce  having 
been  drawn  back  over  the  glans  penis,  the  latter  becomes  constricted 
and  swollen,  so  that  the  prepuce  cannot  be  replaced. 

Symptoms.  Gx-eat  swelling  of  areolar  tissue  behind  constriction. 
Mucous  membrane  of  withdrawn  prepuce  forms  a  thick  and  brawny 
girdle.     Congestion  of  glans  penis.     Pain,  inflammation,  anxiety,  &c. 

Treatment.  Reduction  :  Parts  to  be  well  oiled  :  glans  to  be  com- 
pressed and  gentl}^  pushed  backwards  with  right  hand,  while  the  pre- 
puce is  di-awn  steadily  forwards  with  the  left.  Compression  of  glans 
sometimes  effected  by  encircling  it  with  a  narrow  strip  of  adhesive 
plaster;  or  by  a  loop  of  tape;  or  by  spoon-bladed  forceps.  Application 
of  ice,  or  stream  of  cold  water,  before  trj-ing  reduction,  sometimes 
useful.  All  fiiiling,  a  notch  or  slight  division  of  tight  preputial  collar 
with  probe-pointed  bistoury. 

Permanent  Cure :  To  prevent  a  recurrence,  circumcision  may  be  ad- 
vantageously practised. — See  Phimosis. 

PARAPLEGIA. — From  Uapardrj^ia,  partial  paralysis;  Tapar.lri<T(7w,  to 
strike  badl}'.  Synon.  Bachiojxiralysis ;  Myeloparalysis ;  Paralysis  Spi- 
nalls. — Paralysis  confined  to  inferior  half  of  body. — See  Paralysis. 

PARASITIC  ANIMALS  AND  PLANTS.— From  Ilapamrico,  to  flatter 
another  and  live  at  his  expense. — See  Eatozoa  ;  JEpizoa ;  Epiphytes. 

PAROTITIS. — From //«/>«,  near;  ouc,  the  ear;  terminal -/f/s.  Synon. 
Cynanche  Parotidea  ;  Mumps. — A  specific  and  contagious  inflammation 
of  salivary  glands,  and  of  parotid  gland  especially. 

Symptoms.  Chilliness.  Slight  fever.  Pains  in  limbs.  Tumefaction 
and  soreness  in  one  or  both  parotid  regions.  Disease  reaches  its  height 
in  four  days;  then  declines.  Yery  rarely  runs  on  to  suppuration.  Oc- 
casionally, during  or  after  decline,  testicles  or  mammas  become  painful 
and  swollen. 

Treatment.  Mild  diet.  Cold  acidulated  drinks.  Ice.  Gentle  laxa- 
tives. Solution  of  acetate  of  ammonia,  349.  Carbonate  of  ammonia. 
361.     Hot  fomentations.     Linseed  poultices. 

PELLAGRA. — From  Pellis^  skin  ;  wyreo,  to  be  sick, — unhealthy  skin. 


200  PELVIC    CELLULITIS. 

Synon.  Mania  Pellagria  ;  Mai  de  Sole;  Elephantiasis  Italica;  Scurvy  of  the 
Alps. — A  severe  constitutional  or  blood  disease  attended  with  an  altered 
state  of  skin.  The  eruption  merely  symptomatic  of  the  vitiated  state 
of  system. — Cause  not  clearly  made  out.  Mostly  ascribed  to  peasants 
living  chiefly  on  maize, — nine-tenths  of  their  food  consisting  of  this 
substance  made  into  polenta  with  coarse  bread,  &c.  Objections  to  this 
theory  :  In  Naples,  Sardinia,  some  parts  of  Switzerland,  &c.,  where 
maize  is  extensively  used,  pellagra  is  unknown  or  is  very  rare.  Landouzy 
found  thirteen  individuals  aff"ected  with  pellagra  in  a  small  town  of 
Aragon,  where  no  maize  is  eaten.  Probably  disease  due  to  insufficient 
nourishment,  and  the  use  of  dry  farinaceous  food  without  sufficient 
fatty  matter. 

Usually  ends  in  mania,  imbecility,  and  slow  death.  Softening  of  pe- 
ripher}"  of  brain  has  been  often  met  with  in  autopsies  :  softening  of  part 
of  spinal  cord  almost  always. — A  common  disease  in  Lombardo-Venetian 
country.  In  1831,  official  returns  showed  that  amongst  the  Milanese 
alone  20,000  individuals  were  suffering  from  pellagra.  Women  more 
liable  than  men. 

Symptoms.  The  pellagrosi  the  most  afflicted  of  individuals.  Disease 
begins  insidiously  at  commencement  of  warm  spring  weather,  with  a 
shining  red  spot  suddenly  arising  on  back  of  hand  or  some  part  of  body. 
This  spot  elevates  skin,  and  produces  numerous  small  tubercles.  Epi- 
dermis dries  and  cracks,  f{\lls  off;  but  shining  redness  underneath  con- 
tinues. At  end  of  summer,  ei'uption  generally  disappears;  suspended 
till  following  spring,  when  it  reajipears.  This  first  stage  may  go  on 
thus  for  seven  or  eight  years. — The  second  stage  is  characterized  by  the 
disease  setting  in  with  greater  constitutional  disturbance,  general  de- 
bility, disturbance  of  nervous  system  (despondenc}',  cramp,  spasm). 
Convulsions  severe  :  when  paroxysm  ends,  patient  becomes  a  pre}'  to 
melancholy  of  a  religious  character  with  suicidal  tendency.  At  end  of 
autumn  there  is  a  remission,  but  less  marked  than  before.  The  next 
year,  symptoms  greatly  aggravated.  Skin  all  over  bod}',  gets  dry, 
rough,  and  shrivelled:  great  debility;  diarrhoea:  breath  and  sweat 
most  offensive:  great  flow  of  saliva.  Pain  in  head,  vertigo,  delirium; 
dyspnoea;  cramps;  bilious  vomiting;  low  fever;  dropsy;  epilepsy; 
and,  surviving  these,  mania,  or  fatuity.  Disease  may  not  prove  fatal 
for  five,  ten,  or  even  fifteen  years.  Its  popular  name — mallattia  di 
miseria — sufficient!}^  justified. 

Treatment.  In  early  stage:  Removal  to  healthy  locality.  Good 
nourishing  food,  with  milk,  fatty  matters,  &c. —  When  fairly  established  : 
All  treatment  useless,  beyond  attempts  at  relieving  the  most  prominent 
symptoms. 

PELVIC  CELLULITIS.— From  Pelvis  {T1e)Mz  or  nw.a),  a  bowl:  Cellnla 
(dimin.  of  cella),  a  little  cell ;  terminal  -itis. — Inflammation  of  the  cellular 
or  areolar  tissue  of  pelvis. — Occurs  mostly  in  connection  with  abortion, 
or  lingering  labor  at  full  term.  Also  as  a  consequence  of  external  vio- 
lence, uterine  disease,  or  some  strumous  state  of  constitution. 

Sy.mptoms.  May  come  on  insidiously.  More  commonly, — Constitu- 
tional disturbance.  Fever,  headache,  restlessness.  Local  pain  and 
throbbing  and  tenderness.  Aching  pains  in  limbs.  Difficult  micturi- 
tion. Tenesmus.  Nausea  and  vomiting.  Painful  swelling,  somewhat 
appreciable  at  lower  part  of  abdomen:  always  detected  by  vaginal  ex- 
amination. 

If  morbid  action  go  on  to  suppuration — Increased  severity  of  general 
symptoms.  Eigors.  Severe  throbbing  and  tenderness.  Neuralgic 
pains  down  thighs.     Fluctuation.     Pus  may  be  discharged  into  upper 


PELVIC    IL'EMATOCELE — PENIS    CANCER.  201 

part  of  vagina  or  bladder,  or  colon,  or  rectum  :  rarel}^  into  peritoneum, 
causing  severe  peritonitis:  or  it  will  burrow  and  make  its  escape  exter- 
nally. Troublesome  sinuses  sometimes  produced.  Pus  formed  again 
and  again  for  months. 

Treatment.  Castor  oil,  ]G4.  Ehubarb  and  magnesia,  1G5.  Citrate 
of  ammonia  or  potash,  362.  Morphia,  chloroform,  and  Indian  hemp,  317. 
0])iate  enemata,  339.  Opium  and  belladonna  suppositories,  340.  Mercu- 
ruil  and  belladonna  pessaries,  423.  Ammonia  and  bark,  371.  Quinine 
and  mineral  acids,  379.  Hot  hip  baths.  Fomentations.  Linseed  poul- 
tices. Hot  water  vaginal  injections.  Milk,  raw  eggs,  beef  tea,  arrow- 
root, tea:  animal  food  as  soon  as  it  can  be  digested.  Wenliam  Lake 
ice.  Sinapisms  to  epigastrium,  if  there  be  sickness.  Abscess  may 
sometimes  be  opened  with  advantage. 

PELVIC  HEMATOCELE. — From  Pelvis,  a  basin;  Alfm,  blood  ;  zij'Atj,  a 
swelling.  Synon.  Retro-uterine  Hcematocele ;  Peri-uterine  Hcematocele. — 
An  effusion  of  blood  into  peritoneal  ])ouch  between  uterus  and  rectum,  or 
into  subperitoneal  tissue  behind  and  around  the  uterus. 

Symptoms.  Vary  according  to  amount  of  loss.  If  excessive, — Nerv- 
ous shock.  Exhaustion  from  internal  hemorrhage.  Acute  pain  in 
lower  part  of  abdomen.  Chilliness  qr  shivering;  coldness  of  extremi- 
ties. Vomiting.  Increased  feebleness  of  circulation.  Ghastly  expres- 
sion of  countenance.     Death  may  occur  in  a  few  hours. 

Where  loss  is  great  but  not  excessive, — Violent  abdominal  pain. 
Sickness.  Chilliness,  followed  by  fever.  Anxietj"  of  countenance  : 
pinching  and  pallor  of  face.  Difficult  micturition,  with  frequent  desire 
to  empty  bladder.  Irritability  of  rectum.  Perhaps,  sudden  cessation  of 
catamenia  if  flow  be  on  at  the  time.  Pelvic  tumor  :  appreciable  through 
abdominal  and  vaginal  walls. 

In  a  third  class  of  cases,  symptoms  of  same  character  but  less  acute 
than  foregoing.  Pelvic  tumor  :  only  appreciable  by  vaginal  examina- 
tion. F'ear  of  peritonitis  :  of  hemorrhage  returning  after  an  interval. 
Absorption  may  be  hoped  for. 

Treatment.  In  acute  cases  :  Brandy.  Wine.  Opium  in  large  doses. 
Sinapisms  to  extremities.  Bladders  of  ice  to  lower  part  of  abdomen  and 
vulva. 

Where  loss  is  moderate:  Perfect  repose  in  recumbent  posture.  Opium 
in  sufficient  doses  to  relieve  pain  and  prevent  faintness.  Gallic  and 
aromatic  sulphuric  acids,  103.  Alum  and  sulphuric  acid,  115.  Ice.  Sin- 
apisms to  epigastrium.  Cold  applications  to  vulva.  Catheterism.  Punc- 
ture of  prominent  part  of  tumor  with  trocar?  Rest  and  care  at  two  or 
three  succeeding  catamenial  periods. 

PEMPHIGUS.— From  /7.V.^;|,  a  bubble  or  blister.  Synon.  Febris  Bul- 
losa; Bladdery  Fever  ;  Weiterblehs. — A  non  contagious  skin  disease.  Char- 
acterized by  large  round  or  oval  vesicles,  or  bullae  (Bulla,  a  bubble  of 
water),  two  or  three  inches  in  diameter,  which  appear  on  one  or  more 
regions.  Each  bleb  filled  with  alkaline  serum;  which  soon  loses  its 
transparency,  becoming  acid  and  puriform.     Slight  fever,  &c. 

Pompholyx  (/7o//^oq  a  blister)  is  merely  a  variety  of  pemphigus. 

Treatment.  Ammonia  and  bark,  371.  Nitro-hydrochloric  acid,  378. 
Quinine  and  steel,  380.  Cod-liver  oil.  Effervescing  citrate  of  magnesia, 
IGC.  Arsenic,  quinine,  and  steel,  381.  Chlorate  of  potash.  Iodide  of 
potassium.     Vesicle  to  be  punetui-ed  :  cuticle  not  to  be  removed. 

PENIS  CANCER. — Carcinonia  of  the  male  organ  is  generally  of  the 
epithelial  kind.     Commences  as  a  warty  or  cauliflower-looking  growth 


202  PERFORATION    OF    STOMACH PERICARDITIS. 

on  inner  surface  of  prepuce  :  followed  by  unhealth}^  and  very  destructive 
ulceration.  Lymphatics  on  dorsum  of  penis,  and  the  glands  in  the 
groin  gradually  get  involved.  Sanious  discharges.  Retention  of  urine. 
Cancerous  cachexia.  Painful  death. — The  disease  may  result  from  irri- 
tation of  retained  secretions  of  corona  glandis  in  phimosis,  where  there 
is  predisposition  to  cancer. — Early  and  complete  amputation  offers  the 
only  hope  of  cure.  The  author  has  had  a  case  under  treatment,  where 
the  penis  was  amputated  for  relief  of  disease  of  a  "cancerous  nature" 
by  ]\Ir.  Clement  of  Shrewsbury  in  the  year  1847;  the  patient  having 
died  (June,  18G6),  from  cancer  of  the  face  and  left  tonsil,  after  enjoying 
good  health  for  nearly  seventeen  years. 

PERFORATION  OF  STOMACH.— In  cancerous  as  well  as  in  simple 
ulceration  of  stomach  perforation  may  occur,  with  escape  of  contents 
into  peritoneum.  Where  this  viscus  has  contracted  adhesions,  a  com- 
munication may  fortunately  only  form  between  stomach  and  outside  of 
abdomen  ;  or  between  stomach  and  colon  or  duodenum  ;  or  even  between 
stomach  and  pleural  cavities,  lungs,  or  pericardium. — See  Gastric  Ulcer; 
Gastric  Cancer;  Gastro- Cutaneous  Fistula;  Gastro- Colic  Fistula. 

PERICARDITIS.— From  rhfu,  about;  xap>Jia,  the  heart;  terminal  -itis. 
Synon.  Exocarditis ;  Inflammation  of  the  Pericardium. — Inflammation  of 
the  external  fibro-serous  covering  of  heart.  May  be  regarded  as  a  local 
manifestation  of  constitutional  disease.  Occurs  most  frequently  in  con- 
nection with  acute  rheumatism,  Bright's  disease,  ichorha^mia,  and  scurvy. 

Symptoms.  Sometimes  so  slight  that  disease  is  not  suspected.  When 
there  is  only  a  slight  exudation  of  fibrine,  or  when  effused  serum  has 
been  rapidly  absorbed  and  adhesions  early  affected,  there  may  be  only 
a  feeling  of  fever  and  oppression.  If  effusion  be  copious  (hydro-peri- 
cardium) so  as  to  press  on  heart  and  embarrass  its  movements,  or  when 
there  is  coexistent  myocarditis,  sjnnptoms  much  more  decided.  High 
fever,  as  ascertained  by  thermometer;  pain  in  cardiac  region,  darting 
through  to  left  scapula,  upwards  to  left  clavicle  and  shoulder,  and  down 
arm;  tumultuous  action  of  heart ;  irregularity  of  pulse;  dyspnoea;  in- 
ability to  lie  on  left  side;  anxiety  of  countenance ;  noises  in  ears,  giddi- 
ness, epistaxis,  &c.  As  disease  advances, — Extreme  debility,  cough, 
suffocative  paroxj^sms,  tendency  to  s^-ncope,  oedema  of  face  and  extremi- 
ties.   Great  restlessness,  distortion  of  features,  tetanic  spasms,  delirium. 

Physical  signs  :  (1)  Sensations  of  friction  communicated  to  hand.  (2) 
Friction  sounds;  an  alternate  rubbing,  or  to-and-fro  sound.  (3)  Exten- 
sion of  dulness  over  heart,  owing  to  serous  effusion.  (4)  Friction-sounds 
attended  with,  or  preceded  by,  valvular  murmurs.  (5)  Signs  of  eccen- 
tric pressure  analogous  to  those  of  empyema.  (6)  Signs  of  excitement 
of  heart.     (7)  Signs  of  weakness  or  paralysis  of  heart. 

Treatment.  Perfect  quiet  in  bed.  Temperature  of  room  65°  to  70° 
F.  Neutral  salts,  if  there  be  constipation,  141,  144,  150,  152.  Opium, 
in  full  doses.  Opium  and  belladonna,  344.  Bicarbonate  of  potash  (gr. 
30  every  two  or  three  hours).  Bicarbonate  of  potash  drink,  355.  Cream 
of  tartar  drink,  356.  Chlorate  of  i)otash  drink,  360.  Poppy-head  fomen- 
tations. Large  linseed  poultices.  Belladonna  and  opium,  over  cardiac 
region,  297.  Vapor  baths. — Light  diet, — gruel,  arrowroot,  milk,  mutton 
broth.    As  soon  as  strength  fails, — Soup,  essence  of  beef,  raw  eggs,  wine. 

When  effusion  is  abundant:  Iodide  of  potassiuin,  31.  Red  iodide  of 
mercury,  54.  A  succession  of  blisters.  As  a  forlorn  hope,  tapijing  of 
pericardium. 

Rem^edies  sometimes  used :  Mercuiy.  Tartarated  antimony.  Digitalis. 
Drastic  purgatives.     Bleeding.     Leeches.     Blisters. 


PERINEPIIRITIC    ABSoEao — PERITONITIS.  203 

PERINEPHRITIC  ABSCESS.  — From  Hep),  around;  >e<ppd^,  the  kid- 
iiov. — Alist'css  of  the  areohir  tissue  surrouuding  the  kidney. — See  Abscess 
of  Abdominal  Walls. 

PERIOSTITIS. — From  Pcriostevm  (Hep),  round  about;  orrzim,  a  bone); 
tei'iniiial  -itis.  Synon.  Iiifiammatio  Pen'ostei. — Inflammation  of  the  peri- 
osteum may  result  from  injury,  sj-philitic  taint,  i-heumatism,  abuse  of 
mercury,  and  from  atmospheric  exposure  acting  upon  broken-down 
constitutions. 

Symptoms.  Pain,  generally  aggravated  at  night;  veiy  acute  if  sub- 
jacent bone  be  involved.  Tenderness.  Thickening  of  inflamed  part 
from  deposit  of  plastic  matter,  forming  a  tense  elongated  swelling, — a 
7iode.  Constitutional  disturbance;  varying  from  slight  impairment  of 
health  to  acute  inflammatory  fever.  Eestless  nights.  Mental  depres- 
sion.    Eigors  indicate  suppuration. 

Treatment.  Calomel  and  opium.  Corrosive  sublimate.  Eed  iodide 
of  mercury.  Iodide  of  potassium,  31.  Syrup  of  iodide  of  iron.  Mor- 
phia and  Indian  hemp,  317.  Cod-liver  oil. —  Locally  :  Leeches,  rest,  and 
hot  fomentations  (in  acute  cases).  Iodine  liniment.  Blisters.  Friction 
with  equal  parts  of  belladonna  and  mercurj'^  liniments.  Subcutaneous 
incisions  through  the  membrane  down  to  the  bone,  to  relieve  periosteal 
tension  when  excessive,  or  to  prevent  sujipuration  when  imminent. 
Early  incision,  through  skin  and  periosteum,  when  there  is  pus  beneath 
the  membrane. 

PERITONITIS. — From  Uspirsi'Mo,  to  stretch  all  over;  terminal  -itis. 
Synon.  Injlammailo  Peritonei. — Inflammation  of  the  serous  membrane 
lining  abdominal  and  pelvic  cavities,  and  investing  the  viscera.  May 
be  acute  or  chronic  : 

1.  Acute  Peritonitis. — Acute  inflammation  of  peritoneum  a  serious  dis- 
ease. Accompanied  with  pain  and  SM^elling  of  abdomen,  and  severe 
symptomatic  fever. 

Symptoms.  Pain,  gradually  extending  over  whole  abdomen.  Some- 
times, chilliness  and  rigors.  High  fever.  Exquisite  tenderness  of  ab- 
domen ;  increased  by  slightest  pressure,  and  by  an}'  movement  calling 
abdominal  muscles  into  action.  Patient  lies  on  the  back,  with  knees 
bent  and  legs  drawn  up.  Abdomen  tense,  hot,  and  often  tympanitic. 
Constipation;  nausea  and  vomiting;  dry  bui*ning  skin;  rapid  feeble 
pulse  ;  hurried  respirations ;  often,  hiccough  ;  and  tongue  thickly  furred. 
Countenance  expressive  of  anxiety  and  suffering.  After  a  time,  belly 
ceases  to  be  tympanitic  but  remains  enlarged  from  cftusion  of  serum. 
When  disease  is  about  to  end  fatally,  abdomen  usually  gets  much  dis- 
tended ;  pulse  thread}^  and  very  quick  ;  face  assumes  a  ghastly  expres- 
sion ;  cold  clammy  sweats ;  and  death  takes  place  from  exhaustion 
within  eight  or  ten  days  of  onset. 

Treatment.  Opium,  344.  Opiate  suppositories,  340.  Opium  and 
aconite,  332.  Opium  and  belladonna,  344.  Poppy-head  fomentations. 
Belladonna  and  opium,  with  fomentation  flannels.  Hemlock  poultice. 
Linseed  poultice.  Turpentine  stupes.  Leeches.  Enemata  of  warm 
soapy  water,  if  there  be  fecal  accumulation  in  colon  or  rectum. 

Diet:  At  Jfirst  to  be  restricted  to  milk  and  water,  tea,  arrowroot,  beef 
tea,  ice,  iced  water,  barley-water.  Lime-water  and  milk,  14.  When 
exhaustion  sets  in,  brandy;  aron*iatic  spirits  of  ammonia;  spirit  of 
ether;  brandy  and  egg  mixture,  17.  Essence  of  beef,  3. — Most  perfect 
quiet.  Air  of  sick-room  to  be  warm  but  pure.  A  cradle  over  abdomen 
to  support  bed-clothes.     Good  nursing. 


204  PERITYPHLITIS PHIMOSIS. 

Remedies  sometimes  employed:  Bloodletting.  Blisters.  Calomel  and 
opium.  Tartarated  antimony.  Tobacco  enemata.  American  hellebore. 
Antiphlogistic  regimen. 

2.  Chronic  Peritonitis. — Sometimes  the  sequel  of  an  acute  attack  : 
more  frequently  an  independent  affection.  May  be  due  to  presence  of 
tubercles  on  peritoneum, —  Tubercular  peritonitis. 

Symptoms.  Somewhat  obscure.  Abdominal  pain  slight.  Attacks  of 
colic  :  perhaps  fever  with  obstinate  diarrhoea.  Tenderness  and  swelling 
of  abdomen.  Nausea.  Anamia  and  wasting.  Abdominal  enlargement 
from  effusion.  When  with  tubercular  peritonitis  there  is  disease  of 
mesenteric  glands,  phthisis,  &c.;  the  case  rapidly  runs  on  to  fatal  ter- 
mination. 

Treatment.  Attention  to  bowels.  Mild  but  nutritious  diet :  milk  or 
cream;  cocoa;  raw  eggs;  solution  of  raw  meat,  2.  Cod-liver  oil.  Iodide 
of  iron.  Quinine  or  bark.  Chemical  food,  405.  Ilypophosphite  of  lime, 
or  soda,  and  sumbul,  419.  Pepsine,  420.  Diluted  iodine  liniment  to 
abdominal  wall.  Iodine  and  cod-liver  oil  ointment,  308.  Iodide  of  cad- 
mium ointment,  312.     Blisters.     Sea  air. 

PERITYPHLITIS.— From  mp\,  around;  to^Ao?,  blind ;  terminal -zYw. 
Inflammation  of  the  areolar  tissue  connecting  the  cacum  with  the  psoas 
and  iliac  muscles. 

Symptoms.  Severe  pains  shooting  from  right  iliac  region.  Diarrhoea 
and  tenesmus.  Nausea.  Mental  depression.  Fever.  —  Parts  around 
seat  of  inflammation  become  swollen.  Frequently  suppuration.  When 
abscess  opens  into  cavity  of  cajcum,  recovery  often  follows. 

Treatment.     See  Ccecitis. 

PERTUSSIS. — From  Per,  very ;  fws5;'.s,  a  cough.  Synon.  Tussis  Con- 
vulsiva ;    Whooping-cough ;   Chincough,  &c. — See  Hooping-cough. 

PHARYNGITIS.— From  i>'ipoY^,  the  gullet;  terminal  -itis.  Synon. 
Cynanche  Pharyngea. — Inflammation  of  the  pharj-nx  not  as  common  a 
disease  as  might  be  expected. 

Occasionally,  especially  in  hospitals  and  workhouses,  walls  of  pharj-nx 
are  affected  with  diffused  erysipelatous  inflam7nation.  Attended  with  low 
difficulty  in  swallowing,  rapidly  increasing  prostration.  Morbid  action 
may  run  on  to  sloughing.  Death  from  exhaustion  not  uncommon. 
The  remedies  are, — Ammonia  and  bark,  371.  Chlorate  of  potash  and 
steel,  402.  Quinine,  379.  Ether  and  brandy,  367.  Wine  or  brandy. 
Haw  eggs.     Eestorative  soup,  2.     Thorough  ventilation  of  sick-room. 

Syphilitic  ulceration  of  velum  and  fauces  may,  after  healing,  produce 
narroM'ing  and  contraction  of  upper  part  of  throat  so  as  to  impede  deg- 
lutition and  obstruct  respiration.  Incising  edges  of  contracted  open- 
ing sometimes  useful.  In  severe  cases,  tracheotom}*.  The  tracheal  tube 
has  been  worn  with  comfort  for  3'ear8. 

Elongation  of  uvula  may  result  from  chronic  inflammation,  or  from  a 
generally  relaxed  state  of  fauces.  By  irritating  pharynx  and  epiglottis 
the  hypertrophied  uvula  produces  a  troublesome  tickling  cough,  with 
occasional  inclination  to  vomit.  Astringent  gargles,  application  of 
nitrate  of  silver,  nourishing  food,  and  ferruginous  tonics  failing  to  cure, 
two-thirds  of  the  organ  had  better  be  snipped  off. — See  Retro-Pharyngeal 
Abscess. 

PHIMOSIS. — From  ^t/j6a,,  to  bind  tight.  Synon.  Ligatura  Glandis ; 
Strictura  Pra'putii. — A  preternatural   constriction  of  the  foreskin,  pre- 


PHLEBITIS — PHLEGMASIA    DOLENS.  205 

vcntini!;  its  being  drawn  back  over  the  glans  penis.  May  be  congenital 
or  acquired. 

Symi'toms.  Iu  children,  a  long  and  contracted  foreskin  often  gives 
rise  to  symptoms  resembling  those  of  stricture,  or  of  stone  in  the  blad- 
der. Irritation,  from  inability  to  wash  away  secretions  of  corona  glandis. 
Ju  adult.s,  it  may  result  from  the  inflammation  of  a  gonorrhoea,  or  of  a 
chancre.  Swelling,  from  inflammation  of  areolar  tissue.  Ii-ritation, 
from  accumulation  of  discharges;  which  may  produce  balanitis,  and  in 
after  life  epithelial  cancer, — if  there  be  any  jiredisposition. 

Treatment.  Palliative:  Warm  bathing.  Fomentations  and  poultices. 
Tobacco  or  belladonna  lotions.  Injection  of  astringent  lotions  under 
prepuce.  Stretching  with  bougies  ;  with  blades  of  dressing  forceps. — 
Radical  cure:  Circumcision.  Slitting  up  of  prepuce  on  dorsal  aspect  as 
far  as  the  corona;  and  stitching  of  edges  of  mucous  lining  to  skin. 
Water  dressing  after  either  operation. — See  Paraphimosis. 

PHLEBITIS. — From  (Pklip,  ^X£,3o^,  a  vein;  terminal  -itis.  Synon.  In- 
flanunatio  Venarum. — Inflammation  of  the  veins  depends  upon,  or  is 
accompanied  by,  a  morbid  state  of  the  blood.  The  history  of  phlebitis 
is  that  of  the  coagula  (thrombi)  formed  within  the  afll'ected  veins,  and 
of  the  metamorphoses  through  w^iich  these  coagula  ]jass  (Virchow). 

Symptoms.  Pain,  increased  on  pressure;  swelling,  stiffness,  and  red- 
ness in  course  of  vessel,  generally  spreading  upwards  towards  heart. 
When  suppuration  results,  rigors  and  flying  pains  in  various  parts  of 
body.  Constitutional  disturbance  always  great.  The  result  of  admix- 
ture of  pus  or  other  morbid  fluids  with  blood  is  to  cause  the  latter  to 
coagulate  :  in  this  way  a  vein  sometimes  becomes  filled  with  a  coagulum ; 
if  morbid  matter  is  of  such  a  nature  that  it  ought  to  be  eliminated,  the 
areolar  tissue  around  inflames,  suppuration  and  abscess  follow^  coats  of 
vein  ulcerate,  and  contained  clot  is  discliai'ged  by  means  of  the  abscess. 
On  the  contrary,  if  poison  does  not  produce  coagulation,  it  mixes  with 
the  blood,  atfects  entire  system,  and  is  subsequently  deposited  in  distant 
parts — lungs,  liver,  spleen,  eye,  joints,  areolar  tissue,  &c. 

Treatment.  Ammonia  and  bark,  371.  Chlorate  of  potash,  61.  Sul- 
phite of  soda  or  magnesia,  48.  Quinine,  379.  Brandy  and  egg  mixture 
with  opium,  318.  Opium,  or  opium  and  belladonna,  344.  Morphia, 
chloroform,  and  Indian  hemp,  317.  Essence  of  beef,  2.  Eggs,  cream, 
and  extract  of  beef,  5.  Lime-water  and  milk,  14.  Port  wine  or  brandy. 
— Perfect  repose.  Fomentations.  Linseed  i:)oultices.  Hemlock  poul- 
tices. 

PHLEBOLITES.— From  ^;iv'',  a  vein;  XiOn^,  a  stone.  Synon.  Vein 
Stones. — Small  calculi,  from  size  of  millet  seeds  to  that  of  peas,  occa- 
sionally found  in  the  veins.  Frequently,  produce  no  obstruction  :  they 
lie  in  dilatations.  Chiefly  composed  of  phosphate  of  lime,  carbonate  of 
lime,  and  animal  matter.  Probabl}'  formed  by  calcareous  deposits  from 
the  blood,  having  a  small  clot  as  a  nucleus. 

PHLEGMASIA  DOLENS.— From  ^Uy<u,  to  burn  :  doleo,  to  be  in  pain. 
Synon.  Phlegmasia  Alba  JJolens ;  (Edema  Lactexun  ;  Crural  Phlebitis ;  Ob- 
structive Phlebitis;  White  Leg ;  Milk  Leg;  White  Swelling  of  Lying-in 
Women. — A  brawny,  non-oedematous,  painful  swelling  of  one  or  both 
low^er  extremities,  attended  with  prostration.  Probably  depends  on 
spontaneous  coagulation  of  blood  within  internal  or  external  iliac  and 
femoral  veins:  coagulation  due  to  some  poisonous  or  acrimonious  fluid 
entering  the  veins,  or  merel}'  to  cachectic  state  of  sj'stem.  Most  prob- 
ably, lymphatics  also  involved:  they  become  obstructed. — Not  uncom- 


206  PHOTOPHOBIA — PHTHISIS. 

mon  after  pai'turition,  especially  in  women  weakened  by  flooding,  &c. 
Frequently  occui's  towards  termination  of  uterine  cancer. — Left  leg 
more  often  attacked  than  right. 

Symptoms.  Commence  in  from  one  to  five  weeks  after  labor.  Fever; 
headaclie;  thirst;  nausea;  pain.  Sometimes,  chills,  or  rigors.  Swell- 
ing and  loss  of  motor  power  in  affected  extremity.  Limb  unnaturally 
hot;  tender;  non-ffidematous,  but  swollen  perhaps  to  twice  its  natural 
size;  of  pale  white  color,  tense  and  elastic  ;  having  a  glazed  or  shining 
appearance. — After  subsidence  of  acute  symptoms,  limb  often  remains 
enlarged  for  many  weeks. 

Treatment.  Acute  stage:  Ammonia  in  effervescence,  362.  Carbonate 
of  ammonia,  36L  Chlorate  of  potash,  61.  Sulphite  of  soda  or  magnesia, 
48.  Hydrochloric  acid.  Opium.  Aconite.  Iodide  of  potassium.  Qui- 
nine. Simple  diet.  Diluents. — Perfect  rest.  Fomentations. — Chronic 
stage:  Iodide  of  iron,  32.  Iodide  of  potassium  and  bark,  31.  Ammonia 
and  bai"k,  371.  Phosphate  of  iron,  405.  Nourishing  food  :  milk,  wine, 
and  malt  liquors. — Bandaging.  Friction  with  stimulating  liniments. 
Cold  water  douche.     Flying  blisters. 

Remedies  sometimes  employed :  Venesection.  Leeches.  Blisters.  Evap- 
orating lotions.  Mercurial  ointment.  Calomel.  Blue  pill.  Digitalis. 
Creasote.     Antiphlogistic  regimen. 

PHOTOPHOBIA.— From  ^w-^  light;  (po6iM,  to  dread.  Synon.  PJmiopho- 
bia ;  Aversion  to  Light. — Intolerance  of  light  is  a  painful  symptom  in 
many  diseases  of  the  eye, — e.  g.,  strumous  ophthalmia,  sclerotitis,  &c.  It 
may  often  be  relieved  by  protecting  the  eye  with  a  large  green  shade 
or  veil,  or  by  spectacles  with  glasses  of  a  neutral  tint.  By  darkening 
the  room,  with  careful  avoidance  of  subsequent  sudden  admission  of 
light.  Hot  fomentations;  or  the  steam  of  hot  water,  medicated  with 
extract  of  belladonna  or  extract  of  poppies.  Hemlock  poultices  over 
eye.  Exposure  of  the  eye  to  the  vapor  of  twenty  or  thirty  drops  of 
chloroform  placed  in  the  warm  hand.  Small  blisters  behind  the  ear,  or 
on  temple.     Painting  skin  of  upper  eyelid  with  tincture  of  iodine. 

The  constitutional  remedies  will  be  those  required  by  the  disease  of 
which  the  photophobia  is  only  one  of  the  results. 

PHRENITIS. — From  ^piiv,  the  mind;  terminal  -itis.  Synon.  Cepha- 
litis;  Ccrebritis  ;  Brain  Fever. — See  Cerebral  Inflammation. 

PHTHIRIASIS. — From  0Oslp,  a  louse.  Synon.  Morbus  Fedicularis; 
Fhtlieiriasis ;  Fediculatio ;  Lousiness. — Human  body  may  be  infested 
with  three  kinds  of  lice  :  Fediculus  corporis  vel  vestimentorum  ;  Fediculus 
ca2)itis  or  head  louse,  and  Fediculus  pubis  or  crab  louse.  All  are  oviparous, 
the  eggs  being  known  as  nits  :  sexes  distinct :  young  are  hatched  in  five 
or  six  days,  and  in  eighteen  days  are  capable  of  reproduction. 

Treatment.  Free  washing  with  yellow  or  soft  soap  and  hot  water. 
Sulphur  bath,  125.  Mercurial  vapor  bath,  131.  Mercurial  ointment. 
Dusting  with  calomel.  Corrosive  sublimate  lotion  (gr.  2  to  fl.  oz.  j). 
Sulphur  ointment.  Cocculus  ointment.  Infusion  of  tobacco.  Nits  to 
be  combed  awa}^,  after  washing  the  hairs  with  vinegar  or  spirits  of  wine. 

PHTHISIS. — From  <pO{(o,  to  waste  away. — Synon.  Tabes  Fulmonum  ; 
Tubercular  Fhthisis ;  Fulmonary  Consumption  ;  Decline. — Phthisis  may  be 
inherited  or  acquired.  Left  lung  suffers  most  frequently.  Apices  and 
posterior  parts  of  upper  lobes  most  frequent  seats  of  deposit  at  first. 
No  period  of  life  exempt  from  this  scourge. — See  Tuberculosis. 


PHTHISIS.  207 

1.  Acute  Phthisis. — This  form  very  rare.  Commences  suddenly  witli  • 
shivering,  fever,  rapid  pulse,  pain,  cough,  dyspnoea.  .Shortly  afterwards, 
hectic  fever,  profuse  sweating,  diarrhoea.  Eapid  degeneration  of  lung 
substance,  cavities  quickly  forming.  Increasing  emaciation.  Death 
from  exhaustion,  perhaps  in  from  three  to  twelve  -weeks  of  commence- 
ment of  disease. — Tubercle  generally  spread  all  through  lungs:  deposit 
oiten  begins  in  middle  and  lovver  lobes. 

2.  Chronic  Phthisis. — The  variety  ordinarily  met  with.  The  tubercle 
ma}'  be  confined  to  one  or  both  lungs;  or  it  may  be  deposited  also  in 
mesenteric  glands,  tissues  of  intestinal  walls,  kidneys,  liver,  nervous 
centres,  &c. 

Symptoms.  Gradually  increasing  cough,  haemoptysis,  debility,  expec- 
toration, loss  of  appetite  and  dislike  to  fatty  food,  dyspepsia,  accelerated 
pulse,  pyrexia,  slight  dj^spnoea,  loss  of  flesh,  sweating,  diarrhea.  "Weak- 
ness of  voice,  or  hoarseness.  A  festooned  appearance  at  reflected  edge 
of  gums.  So  long  as  tubercle  is  being  deposited  the  temperature  of  the 
bod}'  is  raised,  so  that  it  may  reach  to  105°  F.  Dull  aching  pain  under 
clavicles  or  scapulae.    Sometimes,  fistula  in  ano  one  of  earliest  symptoms. 

Haemoptysis  most  frequent  in  early  stage :  it  is  very  rarely  fatal. 
Aphtha^  about  niouth  and  fauces.  Mucous  membranes  of  bronchi,  lar- 
ynx, and  phar3'nx  apt  to  get  affected  with  low  form  of  inflammation: 
tubercle  sometimes  deposited  in  submucous  tissue  of  these  organs.  Dis- 
turbance of  uterine  functions  in  women:  cessation  of  catamenia.  Con- 
gestion and  tenderness  of  liver.  Incurvation  of  finger  nails :  clubbed 
appearance  of  ends  of  fingers.  The  debility  and  emaciation  become 
more  and  more  marked.  Profuse  night  sweats.  Diarrhoea  :  either  due 
to  disordered  secretions,  or  to  ulcerations  about  ileum  and  colon.  Urine 
sometimes  contains  albumen,  or  sugar.  Tenderness  and  oedema  of  ex- 
tremities.    Mental  faculties  usually  remain  clear  until  death. 

Physical  signs:  At  first,  if  tubercular  deposit  be  considerable,  flatten- 
ing of  infra-  and  supra-clavicular  regions.  Defective  expansion  of  u))))er 
and  front  part  of  affected  side.  Dulness  on  percussion.  Harsh  or  tubu- 
lar inspiration.  Act  of  expiration  prolonged.  Bronchial  respiration 
and  bronchophony.  A  systolic  bruit  under  one  or  both  clavicles. — In 
second  stage,  more  marked  depression  of  infra-  and  supra-clavicular 
regions.  Deficiency  of  chest  n^iovement.  Decided  dulness  on  percus- 
sion, unless  amount  of  tubercle  be  small  and  surrounded  b}-  emphyse- 
matous lung.  Large  crepitation.  Puerile  breathing  in  sound  lung. — 
In  third  stage,  great  depression  below  clavicle.  Flattening  of  whole  of 
aftected  side.  Eetraction  of  intercostal  spaces.  Heart's  impulse  seen 
and  felt  at  higher  point  than  normally.  Dulness  on  percussion,  owing 
to  solidity  of  layer  of  lung  forming  wall  of  cavit}'.  Gurgling.  Cavern- 
ous i-espiration,  if  cavity  be  empty  or  nearly  so;  amphoric  resonance 
and  pectoriloquy,  if  it  be  also  large. 

For  diminution  of  Vital  capacity,  see  Spirometry. — For  extent  of  Loss 
of  weight,  see  Weight  of  Body. 

Treatment.  General  rules  :  Improvement  of  general  nutrition.  At- 
tention to  quantity  and  quality  of  food.  Eesidence  in  a  healthy  climate : 
not  necessarily  a  warm  one.  Exercise  in  open  air,  preferabfy  without 
fatigue, — by  driving,  sailing,  &c.  Insuring  purity  of  air  in  apartments 
occupied.  Warm  clothing:  flannel  or  chamois  leather  next  the  skin. 
Daily  tepid  sponging,  preferably  with  saltwater:  friction  with  coarse 
towels,  flesh-brush.  Sti*ength  on  no  account  to  be  lowered :  exacerba- 
tions of  fever  to  be  treated  by  simple  salines,  omitting  tonics  for  a 
couple  of  days  or  so.  In  early  stage,  any  complication  (such  as  fistula 
in  ano)  may  be  cured  by  operation. 


208  PIARH^MIA. 

Diet:  Most  nutritions.  Animal  food,  so  long  as  it  can  be  digested. 
Pepsine,  420.  Milk;  cream;  raw  eggs.  Iceland  moss  and  quinine  jelly, 
13.  Milk,  flour,  and  steel,  16.  Saccbarated  solution  of  lime  with  milk, 
where  there  is  acidity  of  stomach.  Rum  and  milk.  Brandy.  Port 
wine  or  sherry.  Burgundy.  Champagne.  Hungarian  wines  (Ofner 
Auslese,  Szamarodnya  Muscat,  Carlowitz,  &c.).  Stout;  bitter  ale;  Scotch 
ale;  Guinness'  stout.    Too  long  an  interval  not  to  elapse  between  meals. 

Change  of  air  and  scene:  Very  valuable  in  early  stages.  Patients  re- 
quiring a  relaxing  or  sedative  atmosphere  in  this  country  may  be  sent 
to  Torquay,  486.  Undercliff  of  Isle  of  Wight,  434.  Sandgate,  431. 
Hastings,  432.  Penzance,  437. — Where  a  more  bracing  air  is  suitable, 
Bi-ighton,  432.  Southport,  439.  Queenstown,  440.  Western  coast  of 
Scotland,  431. — If  a  more  complete  change  than  this  country  affords  be 
Avished  for,  Mentone,  443.  Cannes,  443.  Ajaccio,  444.  Malta,  449. 
Malaga,  445.  Algiers,  451.  Madeira,  452. — Colony  of  Natal,  453.  Can- 
ada, 454. — When  a  sea  voyage  is  indicated,  Australia  or  New  Zealand, 
457. 

Drugs :  Cod-liver  oil,  389.  Ozonized  cod-liver  oil.  Cod-liver  oil  and 
bark  enemata,  22.  Inunction  with  oil,  283,  Steel  and  cocoanut  oil,  391. 
Steel  and  glycerine,  392.  Hypophosphite  of  soda  or  lime,  419.  Bark 
in  full  doses.  Various  preparations  of  iron,  38U,  394,  397,  401,  403,  405, 
&c.  Iodide  of  iron.  Quinine.  Liquor  potassa?.  Carbonate  of  am- 
monia.— If  there  he  haemoptysis  :  Iron  alum,  116.  Gallic  acid,  103.  Tan- 
nin and  nitric  acid,  99.  Oil  of  turpentine,  102.  Lead  and  acetic  acid, 
117. —  To  relieve  cough:  Opium  or  morphia,  315,  316,  317,  346,  347,  &c. 
Decoction  of  Iceland  moss.  Demulcent  drinks,  19. — If  heart's  action  be 
irritable:  Hydrocyanic  acid.  Digitalis. —  To  check  night-sweats :  Oxide 
of  zinc.  111.  Gallic  acid.  Mineral  acids  with  bark.  Sponging  body 
with  very  hot  water. —  To  check  diarrhoea:  Ehatany,  96.  Catechu,  97. 
Vegetable  charcoal,  98.  Matico  and  rhatany,  105.  Sulphate  of  copper 
and  opium,  106.  Nitrate  of  silver  and  opium,  107.  Kino  and  logwood, 
108.  White  bismuth,  112.  Astringent  enemata,  113. —  To  check  expecto- 
ration, and  lessen  laryngeal  irritation:  Turpentine  inhalations,  260.  Hy- 
drocyanic acid  inhalations,  261.  Inhalation  of  spray  medicated  with 
tannic  acid,  turpentine,  steel,  &c.,  262.  Sponging  epiglottis,  pharynx, 
and  even  interior  of  larjaax  with  solution  of  nitrate  of  silver. 

Local  applications  to  chest  ivalls :  Iodine  liniment.  Dry  cupping. 
Croton  oil  liniment,  303.  Succession  of  small  blisters.  Blisters,  kept 
open  by  savine  ointment  or  by  Albespeyre's  plaster,  208.  Issues,  or 
setons,  below  clavicle.  Frequent  sinapisms.  Turpentine  stupes.  Fric- 
tion with  salt  water;  cod-liver  oil,  283;  salad  oil;  belladonna  and  aconite 
liniment,  281. 

Remedies  which  have  been  recommended:  Pancreatine  and  pancreatic 
emulsion.  Naphtha.  Malt  (Byne).  Bromide  of  Iron.  Peroxide  of 
hydrogen.  Acetic  acid.  Actea  racemosa.  Hydrosulphuret  of  ammonia. 
Iodide  of  ammonium.  Glycerine.  Common  salt.  Sulphur.  Codeia. 
Digitaline.  Phosphorus.  Carbonate  of  lead.  Sanguinaria  Canadensis. 
Arsenic.  Oxalic  acid.  Phosphate  of  lime.  Tartarated  antimony. 
Mercury  and  chalk.  Colchicum.  Excreta  of  reptiles.  Daily  emetics. 
Frequent  small  bleedings.  Inhalations  of  naphtha;  chlorine;  carbonic 
acid;  oxygen  gas;  iodine;  tar  vapor.  Arsenical  cigars.  Stramonium 
cigars.  Turkish  baths.  Laying  open  cavity  by  incision  through  inter- 
costal space,  and  treating  it  as  a  chronic  abscess. 

PIARH.^MIA. — From  IIJap,fixt;  al/ia,  blood.  Synon.  Lipa'viia ;  Pi- 
oxcemia. — Milkincss  of  the  serum  or  fatty  blood  is  met  with  under  cer- 


PIOX^MIA — PLETHORA    OR    FULNESS    OF    RLOOD.  209 

tain  circumstances  in  disease.     Its  physical  causes  are  two — viz.,  free 
fat,  and  molecular  albumen. 

(1)  PiarluTmia  a  physiological  result  of  digestion,  pregnanc3%  lactation, 
and  hibernation.  During  digestion,  lactescence  of  serum  begins  about 
two  hours  after  ingestion  of  aliment,  and  continues  for  two  or  three 
hours.  The  serum  is  turbid,  opalescent,  and  semi-opaque  ;  a  condition 
only  transitory,  and  due  to  absorption  of  fatty  matters  of  food,  formed 
into  an  emulsion  by  pancreatic  juice,  and  absorbed  as  such  in  duodenum. 
Examined  microscopically,  the  serum  is  found  to  contain  a  large  number 
of  fat  globules  and  of  molecular  granules  of  albumen.  The  passage  of 
chyle  into  the  blood  renders  the  serum  turbid;  this  turbidity  lasting 
until  insoluble  fatty  matters — oleine,  stearine,  and  margarine — enter 
into  combination  with  free  soda  of  blood,  and  become  converted  into 
oleic,  stearic,  and  margaric  acids. 

(2)  Lactescent  serum  a  pathological  result  of  disease.  The  cases  in 
which  its  occurrence  has  been  noted  are  diabetes,  chronic  alcoholism, 
dropsy,  jaundice,  nephritis,  hepatitis,  pneumonia,  and  especially  Bright's 
disease. 


PIOXiEMIA.— From  /7cwv,  fat;  al/za,  blood.— Fatty  blood.— See  Pi 

hcemia. 


lar- 


PITYRIASIS. — From  Uiropov,  bran.  Synon.  Herpes  Fvrfuraceus ; 
Branny  Tetter ;  Dandriff ;  Dandruff. — A  chronic,  non-contagious,  squa- 
mous inflammation  of  the  skin;  attended  with  slight  redness  and  much 
irritation.  Characterized  by  production  of  minute  white  scales,  or  scurf, 
in  great  quantity.  May  attack  any  region :  scalp  and  parts  covered 
with  hair  most  common  seats  of  it — pityriasis  capitis.  Desquamation 
takes  place  copiously  and  incessantly,  often  for  months.  When  occur- 
ring in  red  and  rough  patches,  it  is  known  as  pityriasis  rubra. 

Treatment.  Locally :  Warm  baths.  Conium  and  starch  baths,  122. 
Borax  baths,  129.  Gelatine  baths,  122.  Lotion  of  glycerine  and  water, 
equal  parts.  Glycerine  and  lime-water,  286.  Lime  liniment.  Borax 
and  glycerine,  268.  Morphia  and  solution  of  potash,  266.  Nitrate  of 
mercury  ointment,  305.     Calomel  ointment. 

Internally :  Arsenic,  52.  Cod-liver  oil.  Corrosive  sublimate.  Col- 
chicum. 

PLAGUE. — From  Plaga  (j^hyrj)  a  blow  or  wound.  Synon.  The  Black 
Death;  Pestilential  Fever;  Levant  Plague;  Septic  or  Glandular  Pesti- 
lence.— A  continued  contagious  fever,  bearing  a  striking  resemblance  to 
typhus. 

Symptoms.  A  period  of  incubation,  varying  from  a  few  hours  to  three 
weeks.  Petechiae.  Buboes,  from  eflPect  of  poison  on  the  cervical,  axil- 
lary', inguinal,  and  mesenteric  glands.  Carbuncles.  Fever.  Diarrhoea. 
Vomiting.  Great  congestion  and  softening  of  heart,  liver,  and  spleen. 
Intense  prostration.  Suppression  of  urine.  Attacks  of  hemorrhage. 
Convulsions,  coma,  or  fatal  exhaustion. 

Treatment.  Emetics.  Mild  aperients.  Diaphoretics.  Salines.  Min- 
eral acids.  Disinfectants.  Cold  affusion. — Friction  of  body  with  oil,  as 
a  preventive  measure.     Avoidance  of  contact. 

PLETHORA  OR  FULNESS  OF  BLOOD.— Synon.  Polycemia ;  Hcema- 
toplethora ;  Mypero'mia. — Partial  plethora,  or  a  local  congestion  or  de- 
termination of  blood,  is  the  superabundance  of  this  fluid  in  one  or  more 
particular  organs  or  tissues. — See  Hypercemia. 

14 


210  PLEURISY. 

PLEURISY. — From  Uktupa,  the  side;  the  pleurae  being  the  serous 
membranes  which  invest  the  lungs  and  inner  surface  of  thoracic  walls. 
Synon.  Pleuritis ;  Inflammatio  Pleurce ;  Morbus  Lateralis. — Inflammation 
of  the  pleura  runs  an  acute  or  chronic  course.  One  side  only  may  be 
aifected,  or  both — bilateral  pleurisy. 

Symptoms.  Chilliness,  or  slight  rigors.  Fever.  An  acute  lancinat- 
ing pain  in  the  side,  called  a  "stitch  ;"  situated  commonly  below  nipple, 
over  antero-lateral  attachment  of  diaphragm.  Pain  aggravated  by  ex- 
pansion of  lung  in  inspiration,  coughing,  lying  on  affected  side,  and  by 
pressure.  A  short  harsh  cough.  Hot  and  dry  skin  :  temperature  of 
body  varies  from  101°  to  105°  F.  Flushed  cheeks.  Hard  and  quick 
pulse.  Slightly  increased  frequency  of  respirations.  Anxiety  and  rest- 
lessness. Scanty  and  high-colored  urine. — Physical  signs:  At  first  a 
friction  sound ;  caused  by  the  dry  and  inflamed  pulmonary  and  costal 
surfaces  of  the  pleura  rubbing  against  each  other.  This  rubbing  may 
be  felt  by  hand.  It  soon  ceases :  as  the  inflammation  is  resolved,  and 
the  two  surfaces  become  moist  and  smooth  ;  or  tlie  surfaces  get  adherent, 
the  exuded  lymph  forming  a  pseudo-areoiar  tissue;  or  the  surfaces  be- 
come separated  by  effusion  of  serum,  a  kind  of  dropsy  resulting,  known 
as  hydrothorax.  Quantity  of  effusion  varies  from  a  few  ounces  to  several 
pints  :  when  excessive  it  compresses  yielding  lung,  suspends  its  func- 
tions, displaces  heart,  and  somewhat  distends  thoracic  parietes. 

When  pleurisy  ends  in  suppuration,  and  pus  accumulates  in  cavity  of 
chest,  the  condition  is  known  as  empyema.  The  pus  sometimes  forms  a 
bulging  tumor  in  an  intercostal  space,  with  appi"eciable  fluctuation. 
Occasionally,  ulceration  of  costal  pleura  follows,  extends  through 
muscles,  and  forms  an  external  aperture  (a  parietal  fistula)  through 
which  pus  is  discharged.  Or,  pulmonary  pleura  may  be  perforated,  an 
opening  form  into  air-tubes  (a  bronchial  fistula),  and  pus  be  expec- 
torated. 

Whether  matter  eft'used  be  serum,  or  serum  mixed  with  blood,  or  pus, 
there  will  be  dulness  on  percussion.  Auscultation  detects  a  diminished 
respiratory  murmur.  If  lung  be  compressed,  so  that  air  only  enters 
bronchial  tubes,  no  vesicular  murmur  at  all  will  be  heard  ;  but  instead 
bronchial  respiration  and  bronchial  voice  or  bronchophony.  Perhaps  also, 
mgojjhony.  When  compression  is  complete,  so  that  air  cannot  even  enter 
bronchi,  no  sound  will  be  audible.  On  healthy  side,  respiration  puerile. 
Patient  cannot  lie  on  sound  side,  because  movements  of  health}'  lung 
become  impeded  by  superimposed  weight  of  dropsical  pleura.  Affected 
side  enlarged:  intercostal  muscles,  inactive:  spaces,  obliterated  or  even 
bulging  ;  fulness  of  infra-clavicular  region  ;  shoulder  depressed.  Pleu- 
ritic effusion  occurs  most  frequently  on  left  side — When  absorption  of 
effusion  occurs,  and  owing  to  adhesions  the  lung  cannot  expand,  there 
will  be  a  shrinking  inwards  of  affected  side. 

In  latent  pleurisy,  there  may  be  neither  pain,  cough,  or  dyspnoea.  Yet 
effusion  may  occur  until  one  half  of  chest  is  found  full  of  fluid. 

Treatment.  Perfect  rest  in  bed.  Avoidance  of  talking  or  of  full 
inspirations,  so  as  to  prevent  undue  friction  between  inflamed  surfaces. 
A  tine  flannel  bandage  around  chest  lessens  the  movements  of  ribs. 
Large  hot  and  moist  linseed  poultices,  covered  with  extract  of  poppies. 
Poppy-head  fomentations.  Sinapisms.  Turpentine  stupes.  Cupping 
to  three  or  four  ounces,  often  relieves  severe  pain  more  quickly  than 
other  measures.  Aperients,  if  there  be  constipation.  Subcutaneous 
injection  of  morphia,  314.  Opium.  Aconite.  Citrate  of  potash  and 
ammonia,  211.  Ether  and  ammonia,  212.  Diet  of  gruel,  milk,  arrow- 
root, tea,  and  broths.  Soda  water.  Lemonade.  Cream  of  tartar 
drink,  356.    Indian  sarsaparilla  and  barley  water.  20. — Tonics  and  good 


PLEURODYNIA PNEUMONIA.  211 

food,  durino;  convalescence. — Quinine,  nourishing  soups,  and  wine  if 
patient  be  aged,  or  when  symptoms  assume  a  typhoid  character. 

To  promote  absorption,  of  effused  fluids:  Moderate  diet,  free  from  stimu- 
lants. Sinapisms  to  diseased  side.  Flying  blisters,  frequently  repeated. 
F'riction  with  ointment  of  red  iodide  of  mercury.  Iodide  of  potassium, 
31.  Squills,  digitalis,  and  blue  pill,  128.  Iodide  of  iron.  Cod-liver  oil. — 
Tapping  the  thorax,  after  failure  of  foregoing  remedies.  In  empyema, 
tapping  with  use  of  drainage  tube. 

Remedies  sometimes  employed :  Calomel,  or  blue  pill.  Tartarated  anti- 
mony. Colchicum.  Hydrochlorate  of  ammonia.  Hydrocyanic  acid. 
American  hellebore  (Veratrum  viride).  Digitalis.  General  bleeding. 
Leeches.     Blisters. 

PLEURODYNIA.— From  Hkiopa,  the  side ;  6i%vrj,  pain.  Synon.  Pleu- 
ralgia;  Pleurodyne;  Rheumatism  of  Walls  of  Chest;  False  Pleurisy; 
Stitch  in  the  Side. — Chiefly  of  importance,  because  the  pain,  which  is 
often  severe,  ma}^  be  wrongly  attributed  to  pleurisy  or  pericarditis,  or 
even  to  peritonitis. 

Symptoms.  General  health  impaired.  Loss  of  appetite.  Low  spirits. 
Urine  loaded  with  urates  or  phosphates.  In  exceptional  cases,  rheu- 
matism of  joints.  Acute  pain,  often  coming  on  suddenl}^  frequently 
referred  to  infra-mammary  region:  increased  by  a  deep  inspiration,  or 
by  any  movement  which  stretches  the  muscles.  In  nineteen  cases  out 
of  twenty,  muscular  and.  fibrous  textures  of  left  side  of  chest  alone 
affected. 

Treatment.  Ammonia,  aconite,  and  bark,  371.  Iodide  of  potas- 
sium, 31.  Subcutaneous  injection  of  morphia  or  chloroform,  314. 
Cod-liver  oil.  Warm  baths.  Turkish  baths,  130.  Sulphur  baths,  125. 
Belladonna  and  opium  liniment,  281.  Veratria  ointment,  30-4.  Hot 
linseed  poultices.  Sinapisms.  Animal  food :  milk.  Steel,  milk,  and 
flour,  16.     Light  wines.     Brandy  and  soda  water. 

Cupping,  leeching,  blistering,  and  purging  will  only  I'ender  the  dis- 
order more  intractable. 

PLEURO-PNEUMONIA.  —  Synon.  Pleuro-peripnevmonia.  —  Inflamma- 
tion, attacking  simultaneously  the  pleura  and  lung. — Pneumonia  may 
happen  without  pleurisy.  But  when  the  pleura  is  involved  in  the 
inflammation,  the  pneumonia  forming  the  chief  affection,  the  double 
disease  is  known  as  pleuro-pneumonia.  If  the  pleurisy  predominate,  it 
is  sometimes  ca.\\ed  pneumo-pleuritis. — See  Pneumonia. 

PLICA  POLONICA.— From  Plico,  to  twine  together.  Synon.  Tricho- 
sis  Plica;  Trichoma;  Polish  Ringworm. — A  disease  of  the  hair,  probably 
allied  to  common  ringworm  of  this  country.  Endemic  in  Poland,  and 
some  parts  of  Russia  and  Tartary.  Characteinzed  by  tenderness  and 
inflammation  of  scalp;  hairs  become  swollen  and  imj^erfectl}' formed ; 
hair-follicles  secrete  a  large  quantity  of  viscid  reddish-colored  fluid, 
which  glues  the  hairs  together,  and  unites  them  into  tufts  or  felt-like 
masses.  Two  cryptogamic  plants — the  Tricoph^'ton  tonsurans  and 
Tricophyton  sporuloides — have  been  detected  by  a  minute  examination. 
Sometimes,  matted  hairs  loaded  with  pediculi.  Disease  not  confined  to 
scalp,  but  may  involve  hairs  on  any  part  of  integument.  Odor  from 
affected  parts  said  to  be  most  disgusting. 

Treatment.     See  Tinea. 

PNEUMONIA. — From  Uvsuiiovia,  a  disease  of  the  lungs.  Synon.  Pul- 
monitis ;    Inflammatio  Pulmonum ;   Peripneumony. — Acute   inflammation 


212  PNEUMONIA. 

of  the  substance  of  the  lungs.  Eight  lung  suffers  twice  as  often  as  left. 
Lower  lobes  more  frequently  attacked  than  upper.  Average  duration 
of  uncomplicated  cases  about  fourteen  days. 

Symptoms.  Disease  ushered  in  with  restlessness  and  general  febrile 
disturbance.  At  end  of  one  to  three  days,  rigors;  followed  by  nausea, 
cough,  expectoration  of  viscid  and  rust-colored  sputa,  pain  in  side,  dis- 
tressed breathing,  a  pulse  reaching  to  140  or  even  160  beats  in  minute, 
temperature  of  body  raised  perhaps  to  105°  F.,  thirst,  loss  of  apj)etite, 
prostration,  headache,  and  perhaps  transient  delirium. 

Each  case  may  be  said  to  consist  of  three  stages  :  (1)  That  of  en- 
gorgement or  splenization,  in  which  substance  of  affected  part  gets  loaded 
with  blood  or  bloody  serum.  On  auscultation,  minute  crepitation,  or 
crepitant  rhonchus,  is  heard;  at  first,  mingled  with  vesicular  murmur. 
Percussion,  at  commencement,  affords  natural  resonance,  which  gradu- 
ally becomes  obscured. — (2)  If  the  inflammation  proceed,  it  passes  into 
stage  of  red  hepatization ;  in  which  spongy  character  of  lung  is  quite 
lost,  and  it  becomes  hard  and  solid.  JSTeither  minute  crepitation  nor 
vesicular  murmur  can  now  be  heard:  bronchophony  often  present,  with 
bronchial  respiration.  Dulnees  on  percussion. — (3)  When  disease  still 
advances,  there  is  reached  the  stage  of  gray  hepatization,  or  purulent  in- 
filtration; consisting  of  diffused  suppuration  of  pulmonary  tissue,  parts 
of  lung  remaining  dense  and  impermeable.  Often,  no  true  suppuration: 
appearance  of  such  simulated  by  liquefied  exudation  matter.  When 
portion  of  lung  breaks  down  and  pus  is  expectorated,  large  gurgling 
crepitation  will  be  heard. — If  inflammation  subside  before  reaching 
stage  of  purulent  infiltration,  as  it  often  does,  the  hepatized  state  ma}' 
remain  permanent  or  gradually  cease.  In  latter  case,  air  begins  to  re- 
enter affected  part  of  lung;  as  evidenced  by  return  of  minute  crepita- 
tion, mingled  with  and  then  superseded  by  healthy  vesicular  murmur. 

For  first  day  or  two  of  pneumonia  a  normal  amount  of  chlorides  will 
be  found  in  the  urine;  the  quantity  diminishing  as  inflammation  ad- 
vances, until  they  have  disappeared  by  time  hepatization  is  complete. 
As  latter  recedes,  tbe  chlorides  reappear.  A  deficiency  of  chloride  of 
sodium  in  urine  not  peculiar  to  pneumonia. — Occasionally,  in  depressed 
constitutions,  pneumonia  ends  in  diffused,  or  in  circumscribed,  gangrene. 

Chronic  pneumonia  may  occur  as  sequel  of  acute  disease;  giving  rise 
to  persistent  consolidation  of  a  portion  of  pulmonary  tissue.  May  be 
mistaken  for  solidification  due  to  tubercle.  It  causes  weakness,  emacia- 
tion, cough,  attacks  of  feverishness,  loss  of  appetite,  and  sense  of  op- 
pression about  chest. 

Treatment.  Acute  form:  Perfect  rest  in  bed.  Temperature  of  sick- 
room not  to  fall  below  65°  F.  Air  to  be  kept  moist  by  steam.  A  dose 
of  castor  oil,  if  there  be  constipation.  Solution  of  acetate  of  ammonia, 
211.  vSmall  doses  of  opium,  if  there  be  pain  or  restlessness.  Vapor  of 
chloroform,  to  relieve  cough  and  dyspnoea.  Carbonate  of  ammonia,  if 
there  be  much  debility,  212.  Large  linseed  poultices,  or  poppy-head 
fomentations,  to  aftected  side  of  chest.  Turpentine  stupes.  Light  diet, 
with  plenty  of  cold  water.  Strong  beef  tea,  wine  or  brandy,  milk  or 
cream,  as  soon  as  there  are  indications  of  exhaustion.  During  convales- 
cence: Milk,  raw  eggs,  wine,  animal  food.  Ammonia  and  bark,  371. 
Quinine  and  steel,  380.     Cod-liver  oil. 

Chronic  pneumonia  :  Iodide  of  potassium  and  bark,  31.  Iodide  of  iron, 
32.  Ilydrochlorate  of  ammonia.  Cod-liver  oil.  Nourishing  food. 
Turpentine  stupes.     Iodine  liniment. 

Remedies  sometimes  employed  :  Tartarated  antimony.  Calomel.  Vera- 
trumviride.    Bloodletting.    Leeches.    Blisters.    Antiphlogistic  regimen. 


PNEUMOTHORAX — POISONS.  213 

PNEUMOTHORAX.— From  IhEwim,  air;  8mpa^,  the  chest.  83-11011. 
Piieumafothorax ;  Emj)hysema  Pectoris;  Aerothorax. — A  collection  of  air 
ill  the  pleura.  When,  as  generally  happens,  there  is  liquid  with  the  air, 
the  disease  is  called  Pneumothorax  ivith  Effusion. — May  arise  from  injury 
b^"  jagged  ends  of  a  broken  rib:  from  an  external  penetrating  wound: 
from  ulceration  owing  to  extension  of  a  tubercular  cavity. — Physical 
signs:  Great  resonance  on  percussion;  with  indistinctness  of  respiratory 
murmur  on  auscultation.  Amphoric  resonance.  Metallic  tinkling,  on 
practising  succussion,  in  pneumothorax  with  effusion. — In  some  rare  in- 
stances, the  dyspnoea  has  been  so  urgent  that  the  air  has  had  to  be 
evacuated  by  puncturing  pleural  cavity  with  a  grooved  needle. 

POISONS. — Consist  of  any  matters  which,  when  absorbed  into  the 
blood,  are  capable  of  destroying  life.  "Deadly  poisons"  are  such  sub- 
stances as  rapidl3^  prove  fotal  in  small  doses.  The  term  '"  destructive 
thing"  is  applied  to  any  mechanical  ii-ritant, — such  as  jiins,  needles,  par- 
ticles of  iron  or  glass,  sponge,  &c. 

Poisons  are  arranged  according  to  their  action  into  three  classes, — 
Irritants,  Narcotics,  and  Narcotico-lrritants.  Another  division  is  into 
Irritants  and  I^eurotics ;  the  latter  consisting  of  Narcotics  or  Cerebral 
poisons,  and  Nai'cotico-Irritants  or  Spinal  and  Cerebro-spinal  poisons 
(Taylor). — See  Poisons,  in  Tabular  Synopsis. 

Symptoms.  Irritants:  Give  rise  to  pain  in  stomach  and  bowels,  sick- 
ness, purging  with  tenesmus.  Evacuations  often  tinged  with  blood  : 
pulse  feeble  and  irregular:  skin  cold.  Many  irritants  corrode  the  tie- 
sues  with  which  they  come  in  contact;  hence  the}-  produce  severe  burn- 
ing sensations  in  mouth,  oesophagus,  and  stomach.  The  degree  of 
chemical  action  produced  will  vary  in  proportion  to  amount  of  water 
with  which  noxious  agent  has  been  diluted.  They  cause  death  by  in- 
ducing collapse,  or  convulsions;  or  by  exciting  severe  inflammation ;  or, 
after  a  variable  interval,  by  leading  to  stricture  of  oesophagus.  Diseases 
which  most  resemble  action  of  irritants  are, — Malignant  cholera,  severe 
diarrhoea,  colic,  gastritis,  enteritis,  rupture  of  stomach  or  intestines, 
trichiniasis,  and  obstruction  of  bowels. 

Narcotics :  Act  on  brain  and  spinal  cord,  inducing  headache,  drowsi- 
ness, giddiness,  stupor,  and  insensibility.  Frequently  there  are  convul- 
sions; sometimes  paralysis.  Very  seldom  vomiting  or  diarrhoea.  The 
symptoms  of  apoplexy,  epilepsy,  and  uramia,  bear  a  resemblance  to 
those  caused  by  poisons  of  this  class.  With  regard  to  one  intensely 
powerful  agent  (nitro-benzole)  the  sj^mptoms  may  not  come  on  for  a 
few  hours,  unless  several  drops  have  been  taken.  In  the  latter  ease, 
there  is  rapid  coma  and  death. 

Narcotico-lrritants  :  Produce  great  thirst,  pain  in  throat  and  stomach, 
vomiting  and  purging,  delirium  with  spectral  illusions,  and  rarely  con- 
vulsions. Sometimes  tetanus,  sometimes  coma  or  sjnicope.  Diseases 
of  brain  and  spinal  cord  often  very  insidious  in  their  progress:  hence 
they  give  rise  to  symptoms  which  maj'  be  improperl}-  attributed  to 
poisoning.  The  history,  mode  of  attack,  &c.,  should  serve  to  prevent 
error. 

Treatment.  The  object  of  practitioner  maj'^  be  comprised  under 
three  heads:  (1)  To  promote  discharge  of  poison  from,  system.  When  the 
poison  has  been  introduced  into  stomach,  recourse  to  be  had  to  stomach- 
pump  or  to  emetics.  The  stomach-pump  is  the  best  instrument  for 
emptying  the  stomach,  washing  it  out,  and  administering  the  antidote. 
Its  emploj'ment  not  advisable  in  poisoning  by  corrosives,  as  it  might 
cause  laceration  of  tissues,  or  even  perforation  of  oesophagus  or  stomach. 
When  used,  less  fluid  should  be  withdrawn  than  is  pumped  into  stomach. 


214  POISONS. 

If  stomach-pump  cannot  be  employed,  emetics  must  be  trusted  to,  unless 
the  poison  has  itself  produced  sufficient  vomiting.  Sulphate  of  zinc, 
rapid  in  action  and  but  slightly  depressing  in  its  effects,  232.  Mustard 
useful,  232.  In  poisoning  by  opium  and  other  narcotics,  when  other 
emetics  fail,  sulphate  of  copper  often  acts  well,  232.  Ipecacuanha  use- 
ful, especially  for  children,  231.  A  warm  and  stimulating  emetic  can 
be  made  with  ipecacuanha  and  ammonia,  283.  Vomiting  may  also  be 
excited  by  tickling  the  fauces:  by  free  administration  of  hot  water,  or 
of  hot  greasy  water. 

When  poison  has  been  administered  by  rectum,  or  when  it  is  thought 
to  have  passed  from  stomach  into  bowels,  enemata  are  necessary.  Salt 
and  water,  oil  and  barley  water,  soap  and  water,  188.  Castor  oil  and 
turpentine,  190.     Croton  oil,  191. 

When  poison  has  been  applied  through  wound  in  skin,  absoqjtion  to 
be  prevented.  Ligature  between  trunk  and  wounded  part,  as  near 
latter  as  possible.  Removal  of  deletei-ious  substance  by  suction  ;  use  of 
cupping-glasses.     Stream  of  cold  water,  long-continued. 

(2)  To  counteract  operation  of  poison  by  antidotes.  No  universal  anti- 
dote known  :  hence  treatment  varies  with  nature  of  substance  taken. 
An  antidote  should  possess  these  properties :  It  ought  to  allow  of  being 
given  in  large  doses  without  danger;  it  should  act  upon  the  poison, 
whether  liquid  or  solid,  at  a  temperature  equal  to  or  below  that  of  body; 
its  action  should  be  quick;  it  should  be  capable  of  combining  with  the 
poison,  though  shielded  by  gastric  juice,  mucus,  bile,  or  other  substances 
contained  in  stomach ;  and  it  should  deprive  the  poison  of  its  deleteri- 
ous properties  (Orlila).  Antidotes  operate  by  forming  harmless  chemi- 
cal combinations,  or  by  producing  insoluble  compounds:  they  thus  de- 
stroy the  poison,  or  prevent  its  absorption.  Purified  animal  charcoal 
has  been  recommended.  It  seems  to  have  the  power  of  combining  in 
the  stomach  with  poisonous  principles  of  animal  and  vegetable  sub- 
stances, so  as  to  produce  innoxious  substances:  when  given  in  large 
quantities  it  will  absorb  some  mineral  substances  (especially  arsenic) 
and  render  them  inert:  about  half  an  ounce  of  charcoal  is  required  to 
each  grain  of  morphia,  strychnia,  or  any  other  alkaloid;  but  much  less 
for  the  drugs  from  which  they  are  obtained,  a  scruple  of  mix  vomica, 
for  example,  not  requiring  more  than  half  an  ounce  of  charcoal:  and, 
lastly,  this  antidote  has  no  injurious  action  on  the  body  (Garrod). 

In  poisoning  by  Mineral  Acids,  the  remedies  are, — Carbonate  of  soda, 
calcined  magnesia,  or  carbonate  of  magnesia,  freely  in  milk  or  any  mu- 
cilaginous fluid.  In  absence  of  these,  whiting,  soap  and  water,  plaster 
of  the  walls.  Olive  oil,  linseed  tea,  gruel,  milk,  barley  water.  If  breath- 
ing be  impeded  by  injury  to  larynx,' tracheotomy.  Subsequently,  reme- 
dies against  gastritis.  External  parts  when  injured,  to  be  bathed  with 
soap  and  water,  olive  oil,  lime  liniment. 

Vegetable  Acids:  Stomach-pump  or  emetics.  Draughts  containing 
magnesia,  chalk,  or  whiting:  mucilaginous  or  demulcent  drinks.  Alka- 
lies"(soda,  potash,  or  their  carbonates)  form  salts  with  oxalic  acid,  which 
are  as  injurious  as  the  acid  itself 

Phospfiorus  :  Vomiting  to  be  encouraged  by  large  draughts  of  muci- 
laginous or  albuminous  drinks.  Full  doses  of  magnesia.  Oil  to  bo 
avoided,  as  it  is  a  solvent  of  this  substance. 

Iodine:  Vomiting  to  be  encouraged.  Free  administration  of  amyla- 
ceous fluids,  as  gruel,  arrowroot,  starch.  Ijatter  to  be  continued  as  long 
as  blue  iodide  of  starch  is  vomited. 

Ammonia,  Potash,  Soda,  and  their  Carbonates:  Vinegar  aiul  water  to 
neutralize  poison.     Acidulated  barley-water,  orange-juice.     The  use  of 


POISONS.  215 

oil  has   been  recommended,  with  object  of  converting  the  alkali  into 
a  soap. 

Nitrate,  Sulphate,  and  Acid  Tartrate  of  Potash :  No  antidotes  known. 
Vomiting  to  be  produced.     Demulcent  drinks. 

Baryta,  and  its  Salts:  Sulphate  of  soda,  or  sulphate  of  magnesia,  or 
some  earthy  sulphate,  so  as  to  convert  the  poison  into  an  inert  and  in- 
soluble sulphate  of  baryta.     Emetics  or  stomach-pump. 

Arsenic:  Stomach-pump.  Emetics.  Vomiting  to  be  kept  up  by 
albuminous  or  mucilaginous  diluents.  Raw  eggs  in  milk.  Eggs,  milk, 
and  lime-water.  Equal  parts  of  oil  and  lime-water.  Castor  oil  (fl.  oz.  ij) 
to  carry  off  any  portion  which  has  passed  into  intestines.  Animal  char- 
coal. Calcined  magnesia.  Hydrated  sesquioxide  of  iron  has  been  un- 
deservedl}^  praised:  if  given,  large  doses  necessary  (a  tablespoonful, 
frequently  repeated).  Subsequent  depression  of  nervous  power  to  be 
combated  by  stimulants  and  opium.  For  any  inflammatory  action, 
opium  or  conium  or  henbane. 

Corrosive  Sublimate:  Vomiting  to  be  encouraged.  Best  antidotes,  al- 
bumen and  gluten  of  wheat:  White  and  yolk  of  several  raw  eggs;  flour, 
made  into  a  paste  with  milk  or  water.  Subsequently,  demulcent  drinks 
and  milk  and  Wenham  Lake  ice.  Gargles  of  alum  and  myrrh,  252; 
tannin,  251;  borax,  250;  chlorinated  soda,  254.  Opiates.  Chlorate  of 
potash,  61.     Iodide  of  potassium,  31. 

Salts  of  Lead:  Soluble  alkaline  or  earthy  sulphates,  as  the  sulphates 
of  soda  or  magnesia.  Milk,  or  milk  and  raw  eggs.  Emetics,  or  stomach- 
pump.  Croton-oil  enema,  191.  In  chronic  lead  poisoning :  Croton  oil, 
168.  Castor  oil  and  opium,  164.  Sulphate  of  magnesia  with  sulphuric 
acid,  142.  Enemata  of  hot  water.  Hot  sulphur  baths,  125.  Opium, 
316,  317,  339,  &c.     Iodide  of  potassium,  31. 

Salts  of  Copper:  Vomiting  to  be  encouraged  by  warm  water.  Albu- 
men, the  only  effectual  antidote.  Hence  several  raw  eggs  are  to  be 
given,  followed  by  milk  or  mucilaginous  drinks. 

Tartarated  Antimony  (Tartar  Emetic):  Vomiting  to  be  encouraged  by 
milk ;  warm  greasy  water.  As  tannate  of  antimony  is  inert,  tea  to  be 
given;  decoction  of  oak  bark;  gallic  or  tannic  acid.  Tinctui^e  of  galls. 
Cinchona  bai'k  in  tincture  or  powder. 

Chloride  of  Antimony  (Butter  of  antimony)  :  Magnesia  in  milk.  Tea; 
decoction  of  oak  bark ;  gallic  acid. 

Sulphate  of  Zinc:  Vomiting  to  be  encouraged  by  milk  or  albuininous 
fluids.     Remedies  containing  tannin,  as  for  antimony. 

Chloride  of  Zinc:  Emetics  and  albuminous  drinks,  followed  by  prepa- 
rations of  tannin. 

Nitrate  of  Silver :  Common  salt.     Emetics,  if  vomiting  be  absent. 

Bismuth :  No  antidote  known.  Vomiting  to  be  promoted.  Emollient 
drinks. 

Chrome :  Emetics.     Magnesia  or  chalk. 

Sulphate  of  Iron  (Green  Vitriol) :  Magnesia  and  diluents. 

Vegetable  and  Animal  Irritants :  Vomiting  to  be  excited  or  encouraged. 
Purgatives.  Linseed  tea,  gum  water,  gruel.  Warm  baths.  Opiates. 
Emollient  enemata.  In  poisoning  by  cantharides,  oil  to  be  avoided,  as 
it  is  a  solvent  of  the  active  principle  (cantharidine). 

Irritant  Gases:  Removal  of  patient  to  pure  air.  Artificial  respiration 
(see  Suspended  Animation).  Cautious  inhalation  of  ammonia,  ether,  or 
steam. 

Opium:  Stomach-pump.  Emetics  of  sulphate  of  zinc,  232:  sulphate 
of  copper,  232  :  of  a  tablespoonful  of  mustard  in  water.  Where  there  ia 
inability  of  swallowing,  emetics  to  be  administered  as  enemata.  Patient 
to  be  prevented  from  sleeping  by  dashing  cold  water  over  head  and. 


216  POLY^MIA POLYDIPSIA. 

chest;  walking  him  up  and  down  in  open  air  between  attendants;  elec- 
tro-magnetic shocks  to  spine ;  flagellation  to  legs  with  a  wet  towel ;  ad- 
ministration of  strong  coffee.  Alcoholic  stimulants.  Artificial  respira- 
tion. Belladonna,  in  from  thirty  to  sixty  minim  doses  of  the  tincture 
every  hour,  as  an  antidote. 

Hydrocyanic  Acid  (Prussic  Acid):  No  antidote  to  be  relied  on.  Chlo- 
rine and  mixed  oxides  of  iron  been  recommended  :  if  they  were  at  hand 
their  efficacy  would  be  doubtful.  Animation  to  be  restored  by  cold 
affusion;  stimulating  frictions  to  chest  and  abdomen  ;  ammonia  to  nos- 
trils. Artificial  respiration.  After  recovery  from  immediate  effects, 
vomiting  to  be  produced.     Strong  coffee.     Brandy. 

Nitro-Benzole  (Essence  of  Mirbane,  Artificial  Oil  of  Bitter  Almonds): 
Strong  coffee.  Brandy.  Ammonia.  Turpentine  enemata.  Cold  affu- 
sion. Galvanism.  Artificial  respiration. — The  same  treatment  is  neces- 
sary in  poisoning  by  Aniline.  No  antidotes  are  known ;  but  it  might 
be  advisable  to  try  the  effects  of  animal  charcoal,  if  the  case  were  seen 
early. 

Chloroform  and  Ether :  Stomach-pump  if  these  poisons  have  been  swal- 
lowed. Where  symptoms  follow  inhalation, — Exposure  of  patient  to 
current  of  pure  air.  Cold  affusion.  Galvanism.  Artificial  respiration, 
313. 

Alcohol :  Stomach-pump.  Cold  affusion.  Solution  of  acetate  of  am- 
monia properl}'  diluted.  Warmth  to  be  promoted.  Sinapisms  to  ex- 
tremities and  cardiac  region. 

Henbane,  Lettuce- Opium,  and  Nightshade:  Emetics.  Full  doses  of  cas- 
tor oil. 

Narcotic  Gases :  See  Suspended  Animation. 

Nux  Vomica,  Strychnia,  and  Brucia :  Emetics.  Stomach-pump.  Pur- 
gative enemata.  Olive  oil.  Animal  charcoal.  Warmth  and  sweating 
to  be  induced.     Perfect  quiet.     Chloroform  to  diminish  tetanic  spasms. 

Belladonna  :  Emetics.     Castor  oil.     Animal  charcoal. 

Aconite:  Emetics.  Castor  oil.  Animal  charcoal.  Strong  coffee.  Am- 
monia or  brandy.  Limbs  to  be  rubbed  with  hot  towels.  Artificial  res- 
piration. 

Digitalis:  Emetics.  Castor  oil.  Infusions  containing  tannin,  as  tea, 
decoction  of  oak  bark,  tincture  of  galls.  Tannic  acid  in  water.  Strong 
coffee  or  brandy. 

(3)  To  remedy  effects  produced  and  obviate  tendency  to  death.  Frequently 
too  long  an  interval  has  elapsed  between  exhibition  of  poison,  and  the 
time  when  emetics  or  antidotes  can  be  of  use.  If  absorption  have  taken 
place,  the  symptoms  must  be  palliated.  In  poisoning  by  depressing 
agents  and  nai'cotics,  or  such  as  destroy  neiwous  fox"ce,  lowering  agents 
to  be  avoided;  whilst  stimulants  and  cold  affusion  and  galvanism  are 
resorted  to.  When  breathing  and  circulation  seem  about  to  cease,  arti- 
ficial respiration  may  preserve  life  till  the  poison  is  eliminated.  To  pro- 
mote elimination,  the  excreting  functions  are  to  be  excited.  Thus,  in 
poisoning  by  arsenic,  the  employment  of  diuretics  has  been  proposed, 
because  it  has  been  found  that  this  poison  is  eventually  carried  off  in 
large  quantities  by  the  urine. 

FOLY^MIA. — From  lloXhq,  much;  al/xa,  blood. — Abundance  of  blood. 
— See  Hyperoemia. 

POLYDIPSIA.— From  noXh^,  much  ;  <5j^'^,  thirst.  Synon.  Sitis  Mor- 
hosa ;  Excessive  Thirst. — A  symptom  in  many  diseases, — fever,  inflam- 
mation, cholera,  diabetes  mellitus,  diuresis,  &c. 


POLYPUS — PROSTATIC    ENLARGEMENT.  217 

POLYPUS. — From  //oAu<r,  many;  tto^c,  a  foot. — A  tumor  so-named 
because  it  was  supposed  to  have  numerous  attachments  or  feet. — See 
Nasal  Polypus ;  Otorrhagia  (for  polypus  of  ear)  ;  Uterine  Tvmors ;  Rectal 
Polypus. 

POLYSARCIA. — From  IJaXhi;,  much ;  ffdp^,  flesh.     Synon.  Carnositas; 

Corpuleniia ;  Steatites.     Excessive  corpulency. — See  Obesity. 

POLYURIA. — From  //oAu?,  much  ;  urea.  Synon.  Azoturia. — A  condi- 
tion in  which  a  hirgcr  quantity  of  urine  than  natural  is  secreted,  con- 
taining an  absolute  and  relative  increase  of  urea. — See  Diuresis. 

PRESBYOPIA. — From  Hpi(Tj3u7,  an  old  man;  w<J',  the  eye.  Synon. 
Presbytia;  Visus  Senilis;  Long-sight. — An  alteration  in  the  refractive 
powers  of  the  eyes,  producing  presbyopia,  or  long-sightedness,  is  one  of 
the  earliest  indications  of  the  commencement  of  old  age.  Seldom  begins 
before  the  forty-fifth  year. 

Symptoms.  The  range  of  accommodation  is  diminished;  vision  is 
imperfect  for  near  objects;  distant  ones  are  seen  clearly.  Often  ac- 
companied by  weakness  of  sight  (amblj^opia).  Rapid  increase  of  pres- 
byopia is  a  precursor  of  glaucoma. 

Treatment.  Convex  glasses  directly  vision  fails  for  ordinar}^  work : 
to  be  so  worn  that  they  can  be  seen  over  at  pleasure  for  distant  objects. 
If  there  be  anaemia,  quinine  and  ferruginous  tonics.  Cold  water  douche 
to  eyes. 

PRIAPISM. — Priapismus,  from  IJpiano^,  the  virile  member;  terminal 
-i(Tlxo<;.  Synon.  Tentigo  Penis;  Horn  Colic. — Constant  and  distressing 
erection  of  penis.  May  arise  from:  (1)  Injury  or  disease  of  spine,  as 
fracture  of  lower  dorsal  or  upper  lumbar  vertebrae.  Disease  of  brain. 
(2)  The  rupture  of  some  vessel,  with  extravasation  of  blood  into  corpora 
cavernosa.  (3)  Subacute  inflammation,  with  eff'usion  of  lymph  into 
corpora  cavernosa.  (4)  Vesicular  and  nervous  excitement,  owing  to 
excessive  venery. 

Priapism  may  sometimes  be  relieved  by:  Bi-omide  of  potassium,  42. 
Iodide  of  potassium,  31.  Henbane,  camphor,  and  hop,  325.  Camphor 
and  belladonna,  326.  Belladonna  suppositories,  with  opium  if  there  be 
pain,  340.  Iodoform  suppositories,  338.  Aconite  or  belladonna  lotions, 
265.     Cold  lotions,  273.     Arnica  lotions,  275. 

PROCTALGIA. — From  llpwxrdt;,  the  rump  or  anus ;  aXyoq,  pain.  Synon. 
Proctagra;  Proctodynia;  Dolor  Ani.  Pain  about  the  anus:  due  to 
neuralgia,  or  to  organic  disease. — See  Rectal  Neuralgia. 

PROCTITIS. — From  /7/>tt;zTo?,  the  rump  or  anus;  terminal -?Y«s.  In- 
flammation of  the  rectum  and  anus. — See  Rectitis. 

PROPTOSIS  OCULI. — From  UpoTzii^Tco,  to  fall  forward :  Oculus,  the 
eye.  A  protrusion  of  the  eyeball,  so  that  the  lids  cannot  cover  it.  Met 
with  in  peculiar  forms  of  anemia. — See  Graves'  Disease. 

PROSTATIC  ENLARGEMENT.  —  Hj^pertrophy  may  result  from 
chronic  prostatitis,  or  in  advanced  life  independent  of  any  inflammatory 
action.  Produces  displacement  or  compression  of  urethra,  so  that  mic- 
turition is  rendered  slow  and  difficult.  The  whole  gland  may  enlarge 
equally,  or  only  the  central  portion.  In  hypertrophy  due  to  inflamma- 
tion, a  cure  may  sometimes  be  eftected  by  a  course  of  mercury.     In 


218  PROSTATITIS — PRURITUS    ANI. 

senile  form,  only  palliatives  are  useful:  Acids,  buchu^  steel,  opiates, 
aperients,  careful  diet,  avoidance  of  cold,  &c.  Care  must  be  taken  that 
the  bladder  is  completely  emptied,  or  chronic  cystitis  will  be  set  up. 
Partial  or  complete  retention  of  urine  requires  the  employment  of  a 
long  catheter  with  a  large  curve. 

Very  rarely  the  prostate  becomes  the  seat  of  cancer, — especially  the 
medullary  form. 

PROSTATITIS.— From  Prostata,  the  prostate  gl&nd—Prosto,  to  stand 
in  front,  this  gland  being  anterior  to  the  bladder ;  terminal  -itis.  Synon. 
Infiammatio  Prostatoi. — Inflammation  of  the  prostate  may  occur  in 
course  of  gonorrhoea,  from  violence,  use  of  strong  injections  to  urethra, 
exposure  to  wet  in  unhealthy  constitutions,  excessive  venery,  diseases 
of  rectum,  and  irritation  of  cantharides. 

Symptoms.  Pain  and  tenderness  about  perineum,  with  sense  of  heat. 
Frequent  painful  micturition.  Pain  during  defecation.  Feeling  of 
weight  about  perineum  and  rectum.  Great  suffering  if  a  catheter  be 
passed.  Aggravation  of  suffering,  rigors,  fever,  difficulty  of  micturition, 
&c.,  w^hen  the  morbid  action  progresses  to  abscess. 

Treatment.  Perfect  rest  in  bed.  Hot  hip  baths.  Fomentations. 
Poultices.  Free  use  of  belladonna  to  perineum.  Opiate  suppositories 
or  enemata,  339.  340.  Simple  nourishment,  without  stimulants.  Col- 
ehieum,  46.  Iodide  of  potassium.  31.  Bromide  of  potassium,  42.  Ily- 
drochlorate  of  ammonia,  60.  Oi)ium,  324,  339,  340,  345.  Aconite,  330, 
331.     Belladonna,  326,  344. 

In  abscess :  Incision  through  perineum  directly  there  is  fluctuation. 
Ammonia  and  bark.  Nourishing  food;  raw  eggs,  cream,  essence  of 
beef,  &c.     Wine,  if  there  be  much  depression. 

PRURIGO. — From  Prurio,  to  itch  ;  terminal  -igo. — A  chronic  non- 
contagious cutaneous  disease,  characterized  by  an  eruption  of  small 
papulas  or  pimples.  Causes  intense  discomfort.  The  term  Prurigo 
should  not  be  used  as  the  synonjnn  of  Pruritus  or  Itching. 

Varieties.  Prurigo  mitis,  the  mildest  form. — Prurigo  formicans,  the 
itching  being  combined  with  a  sensation  like  the  creeping  of  ants  or 
stinging  of  insects. — Prurigo  senilis,  which  occurs  in  old  age,  and  may 
last  for  the  remainder  of  patient's  life. — Irritation  from  prurigo  not  to 
be  confounded  with  that  caused  by  lice.  These  insects  often  j^resent  in 
old  age,  where  there  is  a  want  of  cleanliness. 

Treatment.  Internally  :  Aloes,  gentian,  and  potash,  148.  Sulphate 
of  soda  and  sulphur,  148.  Sulphur  and  magnesia,  153.  Khubarb  and 
magnesia,  165.  Pepsine  and  aloes,  155.  Sarsaparilla  and  iodide  of  iron, 
32.  Tar  capsules,  36.  Arsenic,  52.  Steel  and  ai'senic,  399.  Bark  and 
mineral  acids,  376.  Nitro-hydrochloric  acid,  378.  Quinine,  379.  Nour- 
ishing food,  avoiding  stimulants.     Acidulous  drinks. 

Locally:  Alkaline  baths,  121.  Sulphur  baths,  125.  Conium  baths, 
122.  Creasote  baths,  123.  Applicationsof  vinegar,  lime-water,  tobacco- 
water,  solution  of  corrosive  sublimate,  solution  of  creasote,  solution  of 
bydrochlorate  of  ammonia,  lotions  with  prussic  acid  and  glycerine. 
Ointments  of  aconitine,  tar,  nitrate  of  mercui-y,  sulphur,  &e.  Sponging 
with  apple  vinegar,  and  then  smearing  with  diluted  nitrate  of  mercury 
ointment. 

PRURITUS  ANI.— From  Prurio,  to  itch;  Anus,  the  fundament.^ 
A  very  troublesome  itching  of  anus  not  uncommon  in  cases  of  haemor- 
rhoids, dyspepsia,  intestinal  worms.     Old  people  often  complain  of  it; 


PSORIASIS — PULMONARY   CANCER.  219 

as  do  women  towards  tlie  end  of  pregnancy,  and  such  as  have  uterine 
disease,  or  such  as  have  recently  got  over  the  change  of  life. 

Symptoms.  Severe  itching  of  fundament:  increased  by  heat,  rich 
living,  &c.  Often  prevents  sleep.  The  friction  resorted  to  causes  the 
surrounding  tissues  to  become  thickened  and  furrowed.  Care  necessary 
lest  irritation  be  due  to  pediculi. 

Treatment.  Internally:  Pjlectuary  of  senna  and  taraxacum,  194. 
Confection  of  pepper,  or  sulphur.  JJhubarb  and  blue  pill,  171.  Simple 
enemata,  188.  Arsenic  with  bitter  infusions,  52.  Iodide  of  iron  and 
sarsaparilla,  132.     Tar  pills  or  cai)sules,  36. 

Locally:  Tobacco-water,  2G5.  Corrosive  sublimate  and  prussic  acid 
lotion,  2G3.  Borax,  morphia,  and  glycerine,  268.  Lint  dipped  in  tinc- 
ture of  opium.  Lemon-juice.  Vinegar.  Olive  oil.  Calomel  and  bella- 
donna ointment,  299.  Diluted  citrine  ointment,  305.  Fuller's  earth 
(chiefly  a  compound  of  silica,  alumina,  oxide  of  iron,  and  magnesia). 
Glycerine.     Nitrate  of  silver.     Leeches. 

General  remedies:  Cold  bathing  or  sponging.  Daily  exercise  in  open 
air.  A  diet  free  fi'om  alcohol,  coffee,  and  seasoned  dishes.  Cool  bed- 
room:  to  sleep  on  a  hard  mattress,  without  too  heavy  clothing. 

PSORIASIS. — From  '/"«>/>«,  tetter.  Synon.  Psora  Leprosa ;  Diffused 
Dry  Tetter  ;  Lepra  Diffusa. — A  variety  of  lepra,  the  eruption  being  dif- 
fused over  the  whole  body. — See  Lepra. 

PTOSIS. — From  Utom,  to  fall.  Synon.  Ptosis  Palpebrce;  Blepharopto- 
sis  ;  Prolapsus  Palpebrce. — An  inability  to  lift  the  upper  eyelid  from  palsy 
of  the  third  nerve.  May  be  due  to  cerebral  disease,  to  congestion  of 
brain,  to  simple  debility.  When  there  is  organic  disease,  it  may  be 
accompanied  by  amaurosis. 

PUERPERAL  MANIA. — From  Puerpera  {Puer  and  pario),  a  woman 
in  childbed :  Mav^o/mc,  to  rage. — A  peculiar  form  of  insanity  occurring 
to  women  soon  after  delivery. 

Symptoms.  Commence  with  restlessness,  insomnia,  severe  pain  in 
head,  diminution  of  secretion  of  milk.  Sometimes,  skin  hot  and  dry: 
pulse  full  and  thick:  tongue  thickly  furred.  Often,  great  debility: 
perhaps  prostration  from  flooding,  lingering  labor,  or  some  morbid 
poison  in  system.  Delirium  frequently  violent.  Great  general  irrita- 
bility.    Tendency  to  suicide,  or  child-murder. 

Treatment.  Indications  are,  first  to  arouse  and  support  powers  of 
patient:  second,  to  alla}^  irritability  of  brain  and  nervous  system.  (1) 
,  Brandy  and  egg  mixture,  17.  Ammonia  and  bark,  371.  Quinine  and 
phosphoric  acid,  379.  Cod-liver  oil,  389.  Pounded  beef  in  broth.  Wine. 
Beer.  Milk.  (2)  Extract  of  stramonium,  323.  Extract  of  opium,  343. 
Morphia  and  Indian  hemp,  317.  Subcutaneous  injections  of  morphia, 
314.  Chloroform  inhalation,  313. — Patient  to  be  controlled  by  a  trained 
nurse.  Separation  from  family  and  friends,  unless  symptoms  quickly 
3^ield  to  remedies. 

PULMONARY  APOPLEXY.— From  Pulmo,  the  lungs.— The  effusion 
of  blood  into  the  air-cells  of  the  lungs,  and  its  coagulation  there.  It 
may  be  circumscribed,  the  eft'usion  varying  in  size  from  a  pea  to  an 
orange;  or  it  may  be  diffused  through  the  broken-down  pulmonary 
tissues.  Arises  from  disease  of  heart,  lung  tissue,  bloodvessels,  or 
anaemia. 

PULMONARY  CANCER. — Most  commonly  of  encephaloid  character. 


220  PULMONAKY  CONDENSATION. 

May  occur  as  a  primary  or  secondary  infiltration,  or  as  a  primary  or 
secondary  nodular  deposit.  Generally  associated  with  mediastinal 
cancer.     See  Intrathoracic  Tumors. 

Symptoms.  When  occviYrxng^  primarily ;  Flattening  of  affected  side, 
impairment  of  respiratory  movements,  dulness  on  percussion.  Pain, 
emaciation,  night  sweats,  d3^spnoea,  failure  of  powers  of  life,  purulent 
expectoration,  &c.  Right  lung  most  frequently  affected.  Often,  chronic 
bronchitis  as  a  complication. 

In  secondary  cancer,  symptoms  very  obscure.  Frequently,  dj^spnoea 
the  chief  indication  of  pulmonary  mischief  Both  lungs  usually 
affected. 

Primary  cancer  oi  pleura  very  rare.  Usually  the  disease  is  associated 
with  cancer  of  lung,  pericardium,  mediastinum,  &c.  Deposit  found  as 
small  spots,  or  hard  layers,  or  in  form  of  tumors  which  sometimes 
become  pediculated.  May  be  attended  with  effusion  of  serum,  or  pus, 
or  blood.     Symjitoms  sometimes  simulate  those  of  phthisis. 

Treatment.  Attempts  must  be  made  to  relieve  symptoms  as  they 
arise.  Strength  to  be  supported  by  nourishing  food  ;  cod-liver  oil ; 
stimulants.  If  there  be  much  suffering,  morphia  with  chloroform  and 
Indian  hemp,  317.  Opiate  enemata,  339.  Opiate  suppositories,  340. 
Subcutaneous  injections  of  morphia,  314. 

PULMONARY  CONDENSATION.— Consolidation  of  the  vesicular 
tissue  of  the  lung  may  arise  from  several  causes.  Thus,  it  may  result 
from  pneumonia,  phthisis,  cancerous  deposit.  From  pressure  exerted 
on  lung,  b}^  fluid  poured  out  in  pleurisy ;  by  extravasated  blood,  as  in 
pulmonary  apoplexy ;  by  enlarged  bronchial  lymphatic  glands,  which  are 
arranged  along  sides  of  air-tubes;  b}^  aneurismal  or  other  intrathoracic 
tumors.  A  small  tube,  or  even  a  main  bronchus,  may  thus  become  so 
obstructed  that  air  cannot  pass;  and  as  a  consequence  there  results 
collapse  of  that  portion  of  lung  to  which  the  compressed  bronchus 
leads. 

In  cirrliosis  of  the  lung,  the  vesicular  structure  contains  no  air,  and  is 
infiltrated  by  a  tough  fibrous  and  grajash  material.  Perhaps  there 
may  be  numerous  small  cavities  filled  with  yellowish  viscid  mucus;  the 
cavities  consisting  of  dilated  bronchial  tubes.  If  entire  lung  be  affected 
there  will  be  dulness  on  percussion  ;  exjjansion  movement  scarcely  per- 
ceptible; no  vesicular  murmur ;  but  perhaps  loud  gurgling  rhonchi  on 
forced  inspiration. 

Another  important  form  of  pulmonary  condensation  is  due  to  collapse 
of  the  air-cells  from  the  plugging  up  of  a  bronchial  tube.  This  condition 
sometimes  described  as  disseminated  lobidar  pneumonia,  marginal  pneu- 
monia, carnification,  or  pulmonary  collapse.  It  may  be  acquired  or  con- 
genital : 

In  acquired  pulmonary  collapse,  the  margin  of  lung,  or  an  irregular 
portion  of  one  lobe,  or  an  entire  lobe,  or  the  whole  of  the  organ  may  be 
involved.  Obstruction  owing  to  increase  in  secretion  of  mucous  lining 
of  tubes,  with  inability  to  cough  it  up.  Hence,  not  uncommon  during 
course  of  bronchitis  or  hooping-cough  in  feeble  subjects.  Or,  secretion 
natural  in  quantit}^,  but  unduly  viscid;  while  from  debility  or  old  age 
it  is  expelled  so  imperfectly  that  an  accumulation  takes  place  in  central 
or  some  other  part  of  lung,  and  acts  like  a  plug.  Plwsical  signs, — dul- 
ness on  percussion,  with  an  absence  of  res})iratory  murmur  over  affected 
parts:  unless  morbid  condition  has  been  of  some  duration,  when  these 
signs  may  be  masked  by  occurrence  of  a  kind  of  compensating  emphy- 
sematous distension  of  those  portions  of  lung  anterior  to  obstruction. — 


PULMONARY    GANGRENE — PYEMIA    OR    PYOII^EMIA.  221 

Stimulants,  tonics,  and  restorative  food  are  the  only  remedies  of  any 
value. 

Congenital  non-expansion  of  air-cells  met  with  in  weakly  infants.  Known 
as  Atelectasis,  from  'Jr^Ajj^,  imperfect;  ^/.raffi-,  expansion.  An  infant  so 
affected  looks  as  if  about  to  die.  Often  jaundiced  :  cry  consists  of  a 
weak  whim])er  :  inability  to  suck:  drowsiness  and  exhaustion:  surface 
cold  and  slightly  livid :  chest  but  partially  dilated  by  imperfect  respira- 
tory movements.  The  solidity  will  perhaps  lessen  as  strength  is  gained, 
and  good  health  be  ultimately  attained  ;  or  death  may  occur  from  ex- 
haustion, with  convulsions.  To  obviate  latter,  child  to  be  wrapped  in 
cotton-wool,  and  kept  in  warm  room  ;  hot  bath  once  or  twice  in  twenty- 
four  hours;  friction  of  chest  with  cod-liver  oil  and  soap  liniment;  ad- 
ministration of  milk,  port  wine,  a  few  drops  of  tincture  of  bark,  and 
solution  of  raw  beef  every  two  hours. 

PULMONARY  GANGRENE.— Gangrene  of  the  lung  is  an  occasional 
termination  of  pneumonia  in  enfeebled  constitutions,  -with  a  depraved 
state  of  blood.  Very  rarely  occurs  independentl}'"  of  pneumonia,  from 
some  impediment  to  pulmonary  circulation.  May  be  met  with  in  chil- 
dren as  an  accompaniment  of  cancrum  oris.  The  gangrene  may  be  dif- 
fused or  circumscribed. 

Symptoms.  Great  and  increasing  debility.  Loss  of  flesh.  Hectic 
fever.  Night-sweats.  Weakness  and  rapidity  of  pulse.  Anxiety  of 
countenance.  Cough.  Expectoration  of  frothy  greenish-tinted  sputa, 
which  have  a  most  offensive  odor.  Offensive  putrid  breath.  In  diffused 
gangrene,  patient  soon  sinks  from  exhaustion.  In  the  circumscribed 
form  the  symptoms  come  on  more  gradually,  beginning  with  indications 
of  pulmonary  congestion.  After  a  time  there  may  be  a  little  improve- 
ment; which  slowly  increases,  and  patient  recovers. — In  both  forms, 
the  physical  signs  are  those  of  pulmonary  condensation  ;  with,  subse- 
quently, those  caused  by  destruction  of  tissue  and  the  formation  of  a 
cavity. 

Treatment.  Ammonia  and  bark,  371.  Bark  and  uitro-hydrochloric 
acid.  Tincture  of  perchloride  of  iron.  Quinine  with  a  mineral  acid,  379. 
Solution  of  chlorinated  soda,  76.  Opium.  Compound  tincture  of  ben- 
zoin. Sulphite  of  magnesia,  48.  Chlorate  of  potash.  Inhalation  of  tur- 
pentine vapor,  260.  Inhalation  of  atomized  solutions  of  turpentine,  steel, 
iodine,  or  sulphate  of  zinc,  262.  Inhalation  of  diluted  oxygen  gas.  Cod- 
liver  oil.  Animal  food.  Good  soups.  Milk,  cream,  and  raw  eggs.  Stout, 
or  ale.     Port  wine,  or  bi'andy. 

PURPURA. — From  llofj<pijpa,  a  purple  dye.  Synon.  Malignant  Petech- 
ial Fever ;  Ha^morrhcea  Petechialis. — A  morbid  condition  of  the  blood 
and  capillary  vessels;  leading  to  disintegration  of  the  red  corpuscles, 
with  diffusion  of  their  contents. 

Symptoms.  Languor  and  debility.  Sallow  or  dusky  complexion. 
Epistaxis.  Pains  about  epigastrium.  Craving  for  food.  Palpitation. 
Giddiness.  Constipation.  Sanguineous  effusions  into  different  tissues. 
Small  hemorrhagic  spots  or  petechia.  Large  patches, — vibices  or  ec- 
chj-moses.     Enlargement  and  softening  of  the  spleen. 

Treatment.  Animal  food.  Fresh  fruit  or  vegetables.  Milk.  Wine 
or  beer.  Aloes.  Senna.  Castor  oil.  Bai'k  and  mineral  acids,  376. 
Nitro-hydrochloric  acid,  378.  Quinine,  379.  Arsenic,  381.  Iron,  397, 
399.  'Vinegar.  Nitrate  of  potash  ?  Oil  of  turpentine,  50.  Gallic  acid, 
103,     Citric  acid.     Lemon-juice. 

PYJEMIA  OR  PYOH^MIA.— From  TWov,  pus;  al/^a,  blood.— Blood- 


222  PYELITIS — RECTAL    CANCER. 

poisoning,  owing  to  absorption  of  ichorous  or  putrid  matters. — See  Ich- 
or hcemia. 

PYELITIS. — From  flueXoq,  a  trough;  terminal  -itis. — Inflam.mation  of 
mucous  membrane  lining  pelvis  and  infundibula  of  kidney. — See  Neph- 
ritis. 

PYREXIA. — From  Uop,  fire ;  eyio,  to  bold. — The  febrile  state,  or  an 
attack  of  fever. — See  Fevers. 

PYROSIS. — From  Hupou),  to  set  on  fire.  Synon.  Ardor  Stomachi; 
Water-I/rash. — A  form  of  indigestion  in  which  there  is  frequent  eructa- 
tion of  a  thin,  watery,  and  acid  or  tasteless  fluid.  More  common  in 
women  than  men.  Not  infrequent  in  advanced  life.  Often  exists  in 
connection  with  some  derangement  of  nervous  or  uterine  system;  or 
with  organic  disease  of  stomach,  panci'eas,  or  liver. 

Symptoms.  Pain  at  pit  of  stomach,  followed  by  eructation  of  watery 
and  insipid  or  acid  fluid.  Sometimes  nausea  and  vomiting;  heartburn. 
Often  associated  with  other  symptoms  of  indigestion. 

Treatment.  White  bismuth.  Solution  of  ammonio-citrate  of  bis- 
muth (Schacht's).  Bismuth  lozenges  (officinal).  Bismuth,  with  mag- 
nesia or  soda,  65,  112.  Saccharated  solution  of  lime  and  milk,  14.  So- 
lution of  potash  and  lime-water,  73.  Ammonia  in  eifervescence,  with 
hydroC3'anic  acid,  362.  Carbonate  of  magnesia.  Opium.  Henbane. 
Hop.  Kino.  Powder  of  kino  and  opium.  Compound  powder  of  rhu- 
barb. Aromatic  sulphuric  acid.  Nux  vomica.  Alum.  Nitrate  of  silver. 
Oxide  of  silver.  Oxalate  of  cerium.  Compound  tincture  of  benzoin. 
Gallic  acid.     Tannin  lozenges  (officinal).     Iron  alum. 

For  diet,  &c.,  see  Dyspepsia. 

PYTHOGENIC  FEVER.— Looking  to  the  origin  of  the  typhoid  poison, 
the  appelhition  o^  Pythogenic  Fever  has  been  suggested, — TMOityv^r^z-,  from 
TtbOwv  {-(jfloiiai,  to  putrefy),  and  yzwdut,  to  engender.  Literally,  "  born  of 
putridity"  (Murchison).  Synon.  Enteric  or  Typhoid  Fever. — See  Typhoid 
Fever. 

RABIES. — From  Rahio,  to  rSi\Q.  Synon.  Morbus  Hydrophohus ;  Ra- 
bies Canina  ;  Water-Fright.     Canine  madness. — See  Hydrophobia. 

RACHITIS. — From  ^Pdyiq,  the  spine;  terminal  -itis;  so  named  be- 
cause of  the  opinion  that  the  spinal  cord  is  in  fault.  Synon.  Rhachitis; 
Osteomalacia  Infantum;  Innutritio  Ossium. — See  Rickets. 

RECTAL  CANCER. — May  be  of  scirrhous,  medullary,  or  colloid  form. 
Epithelial  cancer  sometimes  attacks  anus,  and  may  extend  some  dis- 
tance up  the  rectum. 

Symptoms.  Not  we,ll  marked  at  first:  but  little  suff'ering  until  diffi- 
culty in  defecation  arises.  When  practitioner  is  consulted,  coats  of 
bowel  generally  found  extensively  infiltrated  with  cancer,  producing 
considerable  contraction.  Severe  lancinating  pains.  Frequent  attacks 
of  hemorrhage.  Ofl'ensive  muco-purulent  discharges.  Debilit}',  ending 
in  complete  prostration.  Loss  of  flesh.  Cancerous  cachexia,  &c.  Ul- 
ceration into  bladder  or  urethra  in  men  :  frequently,  into  vagina  in 
women.     Death  from  exhaustion. 

Treatment.  Opium,  343.  Opium  and  belladonna,  344.  Opiate  sup- 
positories, 340.  Subcutaneous  injections  of  morphia  or  atropine,  314. 
Morphia,  chloi'ofbrm,  and  Indian  hemp,  317.    Iodoform  pills  or  supposi- 


RECTAL    NEURALOIA — RECTAL    TROLAPSUS,  223 

toricR,  338.  Nourisliing  food:  milk,  cream,  raw  ei!;^8.  Brandy:  wine. 
Formation  of  artificial  anus  in  left  loin  :  so  as  to  jjrolong  life  for  a  few 
months,  and  render  it  more  endurable.  In  epithelial  cancer, — excision, 
cutting  wide  of  affected  tissue,  and  immediateh'^  afterwards  touching  all 
parts  of  raw  surface  with  chloride  of  zinc. — See  Cancer. 

RECTAL  NEURALGIA.— Synon.  Proctalgia.— }il ay  persist  for  many 
weeks,  without  altogether  subsiding  for  a  day.  Pain  aggravated  by 
passage  of  stools.  Tenesmus.  Pain  ma}'  be  confined  to  a  single  spot. — 
To  be  cured  by  nourishing  food.  Pepsine,  420.  Simple  enemata,  188. 
Suppositories  of  opium  and  belladonna,  340.  Quinine.  Zinc.  Steel. 
Cod-liver  oil. — See  Neuralgia. 

An  irritable  sphincter  muscle  causes  pain  in  defecation.  On  introduc- 
ing finger,  the  muscle  grips  it  very  tightly.  Mild  laxatives.  Bougies. 
Belladonna  ointment.     Improvement  of  general  health. 

RECTAL  POLYPUS.— From  /Zr^Au?,  numerous;  ;r«u?,  the  foot,— because 
these  tumors  were  supposed  to  be  attached  by  many  roots. — More 
common  in  children  than  adults.  The  pedunculated  growth  arises  from 
the  mucous  membi'ane;  and  it  may  bo  soft  or  follicular,  or  firm  and 
fibrous. — A  villous  tumor,  resembling  that  sometimes  found  in  urinary 
bladder,  occasionally  grows  with  a  broad  base  from  mucous  membrane 
of  rectum. 

Symptoms.  Uneasiness  about  fundament.  Frequent  desire  to  go  to 
stool.  Mucous  discharges  tinged  with  blood.  In  villous  growths,  per- 
haps abundant  hemorrhage.  A  polypoid  tumor  usually  descends  when- 
ever the  bowels  act. 

Treatment.  Application  of  a  ligature,  and  immediate  removal  of 
tumor  below  it  with  scissors.  If  there  be  no  fear  of  bleeding,  excision 
only. 

RECTAL  PROLAPSUS.— From  Prolabor,  to  glide  forward.  Synon. 
Prolapsus  Ani ;  Proctocele ;  Ectopia  Ani ;  Falling  of  the  Fundament. — 
There  may  be  protrusion  only  of  mucous  lining  of  rectum,  or  all  the 
coats  of  the  bowel  will  be  found  prolapsed.  Caused  by  want  of  tone  in 
sphincter  ani,  constipation,  straining  at  stool,  prolonged  diarrhoea,  irri- 
tation of  worms,  disease  of  urinary  organs,  stone  in  bladder,  &c. 

Symptoms.  At  first,  protrusion  only  occurs  when  bowels  act.  After 
a  time,  descent  follows  any  exertion,  as  standing,  coughing,  &c.  Onl}^ 
a  fold  of  raucous  membrane  comes  down,  or  inverted  bowel  is  forced  out 
to  extent  of  five  or  six  inches.  When  prolapsus  is  almost  constant,  in- 
testinal mucous  membrane  becomes  indurated,  perhaps  ulcerated : 
sphincter  ani  found  much  relaxed.  Discharge  of  mucus  tinged  with 
blood.  A  general  sense  of  weight  and  distress  about  the  body,  with 
severe  pain  on  going  to  stool. 

Treatment.  Eeplacement  usually  effected  without  difficulty.  Some- 
times, especially  in  children,  bowel  descends  immediately  after  reduc- 
tion :  to  be  prevented  by  applying  a  pad  of  lint,  and  drawing  buttocks 
firmly  together  with  a  broad  strip  of  adhesive  plaster.  Advantageous 
to  make  children  pass  their  motions  in  a  recumbent  posture,  so  as  to 
prevent  violent  straining.  General  health  to  be  imj^roved :  bark,  qui- 
nine, glycerine,  steel,  cod-liver  oil.  Constipation  to  be  prevented:  ta- 
raxacum, carbonate  of  magnesia,  cream  of  tartar,  or  mercury  and  chalk. 
After  each  evacuation,  bowel  to  be  replaced:  anus  to  be  sponged  with 
cold  water.  Astringent  enemata  of  alum  and  decoction  of  oak-bark;  or 
of  tincture  of  perchloride  of  iron  and  water;  or  of  infusions  of  matico 
or  rhatany.     Suj^positories  of  tannic  acid  and  cocoa  butter. 


224  RECTAL  STRICTURE— RECTAL  ULCERS. 

Medical  treatment  failing :  Eectal  supporters  worn  for  some  time. 
Production  of  superficial  sloughs  by  application  to  mucous  membrane 
of  nitrate  of  silver,  nitric  acid,  solution  of  perchloride  of  iron,  potassa 
fusa,  or  actual  cautery.  Acid  solution  of  nitrate  of  mercury  objection- 
able :  it  may  cause  salivation.  Excision  of  two  or  three  folds  of  mu- 
cous membrane  and  skin  at  margin  of  anus.  Several  small  folds  of 
mucous  membrane,  at  different  parts  of  prolapsed  bowel,  to  be  taken  up 
w^ith  forceps  and  then  tightly  ligatured :  ligatures  to  be  cut  off  short, 
intestine  returned,  a  dose  of  opium  administered,  and  patient  to  be  kept 
in  bed  until  ligatures  come  away. 

RECTAL  STRICTURE. — Synon.  Rectostenosis ;  Proctostenosis;  Strictura 
Ani. — Stricture  of  rectum  may  be  limited  to  a  ring  of  condensed  tissue, — 
the  annular  form ;  or  it  may  be  confined  to  one  side  of  bowel,  as  when 
it  follows  cicatrization  of  ulcers;  or  almost  the  whole  gut  may  be  nar- 
rowed and  indurated.  To  be  distinguished  from  constriction  due  to 
cancer,  or  to  pressure  of  tumors ;  as  well  as  from  simple  spasmodic  con- 
traction produced  by  irritable  ulcer,  &c. 

Symptoms.  Constipation;  small  stools;  great  diflSculty  in  voiding 
solid  motions.  Straining  and  bearing-down  efforts.  Flatulence.  Pain 
in  loins  and  sacrum.  Mucous  discharges,  sometimes  stained  with  blood. 
Depression  of  general  health :  low  spirits.  If  ulceration  follow,  burn- 
ing pains;  tenderness  about  sacrum  and  fundament;  discharges  of  blood 
and  pus;  considerable  constitutional  disturbance. 

Treatment.  Dilatation  by  bougies :  an  instrument  to  be  passed  oc- 
casionally for  some  months  after  apparent  cure.  SjDonge  tents,  426. 
Slight  notching  of  annular  stricture  with  j^robe-pointed  bistoury,  and 
plugging  with  oiled  lint;  subsequently,  use  of  bougies.  Suppositories  of 
opium  and  belladonna,  340.  Aperient  electuaries,  194.  Simple  enemata, 
especially  of  olive  oil,  188.    Nourishing  food.    Glycerine.    Cod-liver  oil. 

RECTAL  ULCERS. — (1)  Irritable  ulcer  of  rectum,  or  fissure  of  anus.  An 
aj)parently  slight  affection,  but  one  which  causes  great  suffering.  Ulcer 
generally  superficial ;  nbout  one-eighth  of  an  inch  broad  and  one-third  of 
an  inch  long;  seated  immediately  within  anus,  and  generally  towards 
the  coccyx.  Most  common  in  women  ;  sometimes  produces  ovarian  pain, 
irritability  of  bladder,  and  great  pain  during  sexual  intercourse.  Pas- 
sage of  stools  irritates' the  sore;  producing  spasm  of  sphincter  ani,  and 
acute  burning  pain  which  lasts  some  hours. — To  make  a  thorough  ex- 
amination, chloroform  sometimes  needed. — To  heal  the  ulcer,  constipa- 
tion to  be  prevented  by  mild  aperients.  Castor  oil.  Electuary  of  senna 
and  taraxacum,  194.  Dinner  pill  of  pepsine  and  watery  extract  of  aloes, 
155.  Cod-liver  oil.  Nourishing  food,  free  from  stimulants.  Locall}', — 
Mercurial  ointment  and  belladonna,  made  into  a  solid  stick  with  cocoa 
butter,  424.  Ointment  of  nitrate  of  mercury,  305.  Calomel  and  bella- 
donna ointment,  299.  Nitrate  of  silver  to  be  avoided.  A  longitudinal 
incision  through  centre  of  ulcer  and  superficial  fibres  of  sphincter  ani : 
one  or  two  grains  of  opium  immediately  afterwards,  so  as  to  confine  the 
bowels  for  two  or  three  days.  If  an  external  pile  be  present  near  fissure, 
it  should  be  snipped  off. 

(2)  Chronic  ulceration,  with  thickening  of  coats  of  rectum.  May  arise  as 
one  of  secondary  effects  of  syphilis.  May  also  be  due  to  deposit  of 
tubercle;  to  cancer;  or  only  to  a  depressed  state  of  general  health. 
Cause  to  be  removed.  Opiate  and  belladonna  suppositories,  340.  Sub- 
sequent contraction  to  be  prevented  by  bougies. 

(3)  Rodent  ulcer.  This  intractable  disease  is  met  with  at  margin  of 
anus,  the  sore  gradually  creeping  up  rectum.     Requires, — Comjilete 


RECTITIS REMITTENT    FEVER.  225 

excision.  Destruction  with  potential  cauHtics, — chloride  of  zinc,  197. 
Steel  with  arsenic,  381,  399.  Cod-liver  oil.  Sulphate  of  zinc  ointment, 
294.     iSubcutaneous  injections  of  atropine,  or  morphia,  314. 

RECTITIS. —  From  Jiectus,  straight;  terminal  -itis. — because  this  por- 
tion (»f  the  gut  was  supposed  to  be  straight.  Synon.  Proctitis;  Architis. — 
InHaniination  of  the  rectum  and  anus.  A  rare  disease,  now  that  drastic 
purgatives  and  alcoholic  drinks  are  less  abused  than  formerly.  May  be 
produced  by  external  violence,  or  introduction  of  some  foreign  body 
into  gut. 

Symptoms.  Sense  of  intense  heat  around  anus.  Severe  pain  shooting 
up  sacrum  and  back.  Spasmodic  contraction  and  excessive  sensitiveness 
of  sphincter  ani.  Tenesmus,  with  passage  of  dark-colored  gelatinous 
mucus.     Irritability  of  bladder.     Constitutional  disturbance. 

Treatment.  Rest  in  bed.  Milk  and  farinaceous  diet.  Sedative 
enemata,339.  Opiate  suppositories,  340.  Ipecacuanha.  Saline  draughts, 
348.     Hot  hip  baths.     Linseed  poultices. 

REFLEX  PARALYSIS.— From  Reflecto,  to  turn  back.  That  form  of 
palsy  in  M'hich  the  ii*ritation  is  reflected  from  periphery  to  centre.  Dis- 
eases of  uterus,  urinary  organs,  and  intestines,  common  causes  of  this 
form.  To  be  remedied  by  cure  of  cause,  provided  irritation  has  not 
existed  long  enough  to  induce  organic  disease  in  spinal  cord,  —  See 
Paralysis. 

RELAPSING  OR  FAMINE  FEVER.— The  name  of  relapsing  or  recur- 
rent  fever  has  been  bestowed  upon  this  infectious  disease,  because  at  a 
certain  period  of  tlie  convalescence  there  is  a  relapse  of  all  symptoms. 
Epidemics  of  it  have  been  recognized,  during  seasons  of  famine  and 
destitution,  since  1739;  and  have  been  described  under  various  names. — 
Five-day  fever ^  Seven-day  fever,  Bilious  remitteyit  fever,  Mild  yellow  fever, 
Synocha,  and  Irish  famine  fever. 

Symptoms.  There  may  be  a  latent  period  of  three  or  four  days,  or 
not. — Rigors,  frontal  headache,  muscular  pains;  followed  by  fever,  rapid 
pulse,  thirst,  pain  at  epigastrium,  and  vomiting.  Sometimes  great  de- 
sire for  food.  True  petechiae  and  purpuric  spots  perhaps  appear,  but  no 
characteristic  eruption.  Prostration.  On  tifth  or  seventh  day  great 
amendment.  Patient  progresses  steadily  towards  convalescence  ;  when 
about  fourteenth  day  from  commencement  of  symptoms,  there  is  a  re- 
lapse. On  third  or  fourth  day  afterwards,  there  is  again  improvement, 
and  gradual  restoration. — Seldom  fatal:  mortality  about  one  in  forty. 

Treatment.  Gentle  aperients.  Refrigerating  drinks.  P^arinaceous 
diet.  Perfect  repose.  Quinine.  Opium,  VVine.  Tea  and  coffee.  Spong- 
ing  body  with  tepid  water,  or  vinegar  and  water,  138.  If  there  be  jaun- 
dice, nitro-hydrochloric  acid,  378.  Nitrate  of  potash.  Dry  cupping  to 
nape  of  neck.     No  remedy  prevents  the  relapse, 

REMITTENT  FEVER.— From  Pemitfo,  to  abate.  Synon.  Febris  Pe- 
mittens. — The  cause  of  this  disease  being  the  same  as  that  of  ague,  it 
might  be  described  as  miasmatic  ov  paludal  remittent  fever. 

Remittent  fever  varies  much  in  severity  according  to  nature  of  climate 
in  which  the  poison  is  generated.  Autumnal  remittents  of  England  and 
France,  comparatively  mild:  endemic  remittents  of  tropical  climates 
often  very  severe  and  fatal.  The  locality  where  the  fever  prevails  seems 
often  to  impress  some  peculiarity  upon  it,  especially  as  regards  the  na- 
ture of  the  complications  which  arise  :  hence  remittent  fever  has  been 
described  under  the  names  of  Walcheren  fever,  Mediterranean  fever,  Jungle 

15 


226  RENAL  CANCER RENAL  DEGENERATIONS. 

or  Hill  fever  of  East  Indies,  Bengal  fever,  Bilious  remittent  of  West  Indies, 
Sierra  Leone  fever,  African  fever,  &c. 

Symptoms.  The  symptoms  bear  a  resemblance  to  those  of  intermittent, 
fever  except  that  there  is  no  cessation  of  the  fever,  but  simply  an  abate- 
ment or  diminution.  Length  of  remission  varies  from  6  to  12  hours; 
at  the  end  of  which  time  the  feverish  excitement  increases,  the  exacer- 
bation being  often  preceded  by  chilliness  and  rigors. 

Eemissions  usually  occur  in  the  morning:  the  principal  exacerbation 
is  generally  towards  the  evening.  The  disease  may  run  on  for  some  14 
or  15  days,  and  end  in  an  attack  of  sweating ;  or  it  may  merge  into  low 
fever.  In  England,  in  1861,  the  deaths  from  it  were  254;  and  as  99  of 
these  were  in  children  under  5  years  age,  it  is  probable  that  the  first 
number  indicates  a  larger  mortality  than  reall}"  existed.  Infantile  re- 
mittent is  a  form  of  typhoid  fever. 

Treatment.  Principles  to  be  followed,  the  same  as  in  ague.  At- 
tempts to  be  made  to  shorten  the  exacerbation,  and  to  lengthen  the 
remission.— Saline  and  effervescing  draughts,  348,  349,  354.  Cold  drinks, 
— water;  lemonade;  ice;  cold  tea;  cream  of  tartar,  356,  360.  Aperients, 
139,  140,  144.  Emetics  of  ipecacuan,  if  there  be  nausea  without  vomit- 
ing, 231.  Sinapisms  to  epigastrium,  if  there  be  troublesome  vomiting. 
Tepid  sponging,  138.  Cold  affusion,  134.  Wet-sheet  packing,  136.  Sim- 
ple diet.     Avoidance  of  stimulants. 

Directly  remission  takes  place,  from  1  to  6  grains  of  quinine  to  be 
given  every  six  hours :  omitting  it  as  the  hot  stage  sets  in.  At  next 
remission,  to  be  commenced  again. 

Salicin.  Sulphate  of  beberia.  Warburg's  tincture.  Cold  affusion; 
blisters  to  nape  of  neck,  if  stupor  set  in.  If  there  be  jaundice,  turpen- 
tine stupes  or  sinapisms  to  epigastrira.  Nourishing  broths;  raw  eggs; 
and  stimulants  when  depression  follows.  Avoidance  of  mercury  and 
bloodletting  at  any  stage. 

RENAL  CANCER. — The  rarest  form  of  kidney  disease :  most  com- 
}non  during  first  years  of  childhood  and  in  old  age.  Enccphaloid  cancer 
much  more  frequent  than  scirrhus.  When  the  disease  is  primary  only 
one  gland  is  usuall}^  attacked  :  if  secondary,  the  reverse.  Cancerous 
degeneration  usually  commences  in  cortical  substance,  and  thence  ex- 
tends to  medullary  cones  as  well  as  to  pelvis  and  ureters. 

In  primary  cancer,  the  renal  tumor  frequently  attains  an  enormous 
size:  fills  abdominal  cavity,  so  that  it  has  been  mistaken  for  ovarian 
tumor.  In  secondary  form,  kidneys  enlarge  to  smaller  extent:  often 
feel  nodulated  on  surface. 

Chief  symptoms, — Enlargement  of  affected  gland.  Ilsematuria ;  more 
blood  escaping  than  in  cases  of  calculus.  Pain  in  loins.  Sickness.  Ema- 
ciation.    Anasarca:  perhaps  ascites.     Fatal  exhaustion. 

Medical  skill  can  only  relieve  the  prominent  symptoms.  If  passage 
of  urine  be  obstructed  by  blood-clots,  catheter  must  be  used. 

RENAL  DEGENERATIONS.— From  Ben,  a  kidney:  Degenero,  to  de- 
generate.— Three  ditfei'eiit  varieties  of  kidney  disease  included  under 
this  head  :  Fatty,  Amyloid,  and  Cystic  Degeneration. 

1.  Fatty  Degeneration.  —  Synon.  Grannlar  JDegeneration  of  Kidney; 
BrighVs  Disease. — Ma}-  be  the  result  of  acute  desquamative  nephritis ; 
of  strumous  diathesis;  bad  living,  intemperance,  constant  exposure  to 
wet  and  cold,  &c. 

Symptoms.  Gradually  increasing  debility;  frequent  and  irritable 
pulse;  striking  pallor — perhaps  combined  with  puffiness — of  face  and 


RENAL    UEGExXEKATIONS.  227 

skin  generally;  frequent  mielurition,  patient  liaving  to  rise  once  or 
of'tener  in  night  to  pass  water;  dysjiepsia,  with  attacks  of  obstinate 
vomiting.  A  tendency  to  grave  inHanitnations  of  serous  membranes — • 
pericarditis,  peritonitis,  meningitis,  pleurisy;  also  to  amaunjsis,  some* 
times  attacking  both  e3'es,  and  perliaps  due  to  fatty  degeneration  of 
retina.  Anasarca  of  limbs,  with  dropsy  of  diiferent  cavities;  in  rare 
cases  (unless  there  be  coexistent  heart  disease)  anlema  of  lungs,  set- 
ting in  suddenly,  and  rapidly  producing  serious  dyspnoea.  Ultimately, 
convulsions,  due  to  effects  of  retained  urea  upon  nervous  system  ;  coma, 
soon  ending  in  death. 

Characteristic  appearances  of  urine:  Scanty  secretion,  highly  albu- 
minous, of  low  specific  gravity.  In  early^  stages,  generally  free  from 
sediment;  examined  by  microscope,  neither  renal  epithelium,  nor  casts 
of  tubes  found.  After  a  variable  interval,  while  general  characters  of 
urine  remain  unaltered,  there  appears  a  light  cloudy  sediment;  contain- 
ing small  waxy  casts,  in  which  are  entangled  one  or  more  globular  or 
oval  cells  inclosing  numbers  of  oil-globules.  Several  cells  completely 
filled  with  oil,  presenting  appearance  of  dark  opaque  masses.  Usually, 
the  casts  have  adhering  to  their  surface  man}^  small  oil-globules,  which 
have  escaped  from  ruptured  cells;  while  numerous  cells  containing  oil, 
together  with  detached  oil-globules,  are  scattered  over  field  of  micro- 
scope. 

When  the  urine  is  of  natural  color,  highly  albuminous,  and  presents 
a  large  number  of  oily  casts  and  cells,  prognosis  most  unfavorable. 
These  appearances  indicate  as  serious  and  intractable  a  malady  as  tuber- 
cular disease  of  lung  (George  Johnson). 

Treatment.  Palliation  of  symptoms.  Regulation  of  diet :  absti- 
nence from  intoxicating  drinks,  starch,  sugar.  Sea  air.  Occasional 
purgatives, — Compound  jalap  powder;  elaterium,  &c.  Bark  or  quinine. 
Mineral  acids.  Ferruginous  tonics.  Opium  may  be  needed  if  there  be 
great  irritability  and  restlessness  :  it  must  be  prescribed  with  great  cau- 
tion. Hot  water  or  vapor  baths.  Puncture  of  anasarcous  extremities. 
— See  Nephritis;    Urauiua;  Fatty  Degeneration. 

2.  Amyloid  Degeneration. — Synon.  Waxy.ov  Amyloid  form,  of  BrighVs 
Disease. — Waxy,  lardaceous,  or  amyloid  degeneration  of  kidney  prob- 
ably never  exists  alone.  It  renders  kidney  inefficient  as  an  excreting 
organ,  and  ultimately  useless.  Has  often  some  connection  with  scrofula, 
syphilis,  oi-disease  of  bones. 

Symptoms.  Loss  of  strength,  coming  on  gradually.  Lassitude* 
Thirst.  Excessive  secretion  of  urine  :  patient  has  to  rise  two  or  three 
times  during  night  to  micturate.  (Edema  of  feet  and  ankles.  Enlarge- 
ment of  liver  and  spleen.  Urine  albuminous,  of  low  specific  gravity, 
pale  in  color,  of  acid  reaction  :  under  quarter  of  an  inch  object-glass 
delicate  and  transparent  and  waxy  or  hyaline  tube-casts  are  seen,  which 
are  formed  by  the  coagulation  of  an  exudation  from  bloodvessels  into 
tubules  denuded  of  epithelium.  Progress  of  case  slow.  Sooner  or  later, 
anaemia;  diminution  in  quantity  of  urine,  with  increase  of  albumen. 
Diarrhoea,  if  intestinal  mucous  membrane  become  affected  with  waxy 
degeneration.  Ascites,  or  general  dropsy.  Death  from  effusion  into 
pleurai  or  pericardium;  from  bronchitis,  or  phthisis;  from  exhaustion;- 
or  from  convulsions  and  coma  due  to  urtemic  toxfemia. 

Treatment.  Good  may  be  effected  in  early  stage  b}'  sea  air;  nour- 
ishing food  ;  ferruginous  tonics.  If  there  be  any  syphilitic  taint, — Iodide 
of  potassium,  3L  Iodide  of  iron,  32,  890.  Subsequently,  relief  of 
prominent  symptoms. — See  Urcemia. 

3.  Cystic  Degeneration. — Four  forms  of  cystic  disease  may  affect  the 


228  RENAL    PARASITES — RETINITIS. 

kidney:  (1)  Small  scattered  cysts,  few  in  number,  are  often  present  on 
surface  of  kidneys,  or  in  cortical  substance,  without  interfering  with 
functions  of  these  glands.  Very  rarely  such  a  cyst  attains  a  great  size, 
contains  some  pints  of  fluid,  and  forms  an  aj^preciable  abdominal  tumor. 
— (2)  Cysts,  varying  in  size  from  a  pin's  point  to  a  hazel-nut,  are  not 
uncommonly  developed  in  kidneys  aft'ected  with  chronic  desquamative 
neyjliritis.  Result  of  obstruction  of  uriniferous  tubes  by  exudation. — 
(3)  Congenital  cystic  degeneration,  may  be  complete  or  incomplete. 
Infants  sometimes  born  with  large  irregular-shaped  kidneys  made  up 
entirely  of  cysts,  M'ithout  any  trace  of  secreting  tissue.  Usually  com- 
bined with  other  malformations. — (4)  General  cystic  degeneration  may 
occur  gradually  in  adults,  OAving  to  expansion  of  portions  of  uriniferous 
tubes,  with  obstruction  and  atrophy  of  intervening  sections.  Symp- 
toms come  on  ver}^  gradually,  not  very  marked:  perhaps  frequent 
attacks  of  hsematuria,  albuminuria,  pains  about  loins.  Occasionally  en- 
largement of  kidne3's,  so  as  to  produce  distinct  tumors.  Death  from 
some  complication,  or  ultimately  from  urasmia. 

RENAL  PARASITES.— Four  varieties  of  Entozoa  may  infest  the 
kidneys:  (1)  Hydatids,  containing  echinococei.  Very  much  more  rare 
than  in  the  liver.  Sometimes,  renal  hydatid  cysts  discharged  with 
urine  :  perhaps  with  symptoms  like  those  produced  by  passage  of  a 
calculus.  Recovery  may  follow  :  or  cysts  may  be  discharged  at  inter- 
vals for  years:  or  death  occurs  from  rupture  of  parent  cyst  into  parts 
around  kidney,  or  from  its  exciting  inflammation  and  suppuration. 
Opium,  iodide  of  potassium,  and  warm  baths  are  remedies  to  be  tried. 
If  cyst  attain  a  large  size,  puncture  with  a  fine  trocar  may  be  justifi- 
able.— (2)  Distomaha3matobium  :  cause  of  endemic  hematuria  of  Egypt, 
&c.  See  Hcematosoa. — (3)  Tetrastoma  renale  :  said  to  infest  uriniferous 
tubes,  but  no  instance  of  its  occurrence  known  in  this  countr}'. — (4) 
Strongjdus  gigas  :  very  rare.  One  specimen  in  JVLuseum  of  Royal  Col- 
lege of  Surgeons. — See  Entozoa. 

RENAL  TUBERCLE.— Synon.  Tuberculous  Pyelitis. — Much  more  com- 
monly a  secondary  than  primary  affection.  In  former  case,  seldom  de- 
tected till  after  death  :  both  glands  involved.  In  latter,  disease  extends 
from  kidney  to  ureter  and  bladder.  Ijarge  tubercular  cavities  pro- 
duced, Avith  destruction  of  renal  tissue.  Urine  contains  pus,  blood,  and 
tubercular  debris  if  ureter  be  unobstructed.  One  or  both  kidneys  may 
be  affected.  Symptoms,  those  of  tuberculosis;  with  burning  pains  in 
loins,  purulent  and  bloody  urine,  and  rapid  emaciation.  Perhaps,  renal 
tumor;  owing  to  confluence  of  tubercular  deposits,  or  to  gradual  dis- 
tension of  pelvis  by  retained  urine  and  pus.  Death  occurs  from  ex- 
haustion in  course  of  eighteen  months;  from  progress  of  similar  disease 
in  other  organs,  or  from  uraemia,  or  ichorhaimia. 

RETINITIS. — From  Rete^  a  net  or  web ;  terminal  -itis.  Synon.  Tn- 
fiainmatio  Retinae. — Inflammation  of  the  delicate  nervous  membrane 
called  the  retina  occurs  as  a  sympathetic  aftection  in  the  course  of  other 
ophthalmia?.    As  a  simple  idiopathic  inflammation  it  is  exceedingly  rare. 

Symptoms.  Acute  deep-seated  pain  in  ejeball,  extending  to  temples 
and  forehead;  great  intolerance  of  light;  dimiimtion  or  loss  of  })ower 
of  vision;  frequent  sensation  of  flashes  of  light.  Pupil  found  con- 
tracted; iris  loses  its  brilliancy  and  becomes  motionless;  vascularity  of 
the  sclerotic.  Constitutional  disturbance  severe.  High  fever  and  de- 
lirium often  present. — When  acute  symptoms  have  subsided,  the  oph- 
thalmoscope shows  vessels  of  retina  congested  and  varicose;  transpar- 


RETKO-PIIARYNGEAL    ABSCESS — RHEUMATISM.  229 

ency  of  retina  impaired;  while  extravasations  of  V)loo(l  may  often  be 
seen,  owin<j;  to  rupture  of  one  or  more  vessels.  In  untavorable  cases, 
masses  of  black  ])igment  are  visible  on  choroid  and  retina:  these  tissues 
gradually  get  atrophied:  total  blindness  results. 

Generally  caused  by  exposure  to  vivid  light — large  fires,  furnaces, 
&c.  Ileflected  light  very  injurious  to  retina;  hence  jiernicious  effects 
of  glare  from  snow,  or  from  burning  sands  of  tropical  climates. 

Trkatmknt.  Perfect  rest  in  a  darkened  room.  Applications  of  cold 
lotions  or  of  hot  fomentations,  according  to  the  patient's  feelings.  Mild 
purgatives.     Sedatives  to  relieve  pain.     Simple  diet. 

RETRO-PHARYNGEAL  ABSCESS.— From  Retro,  backwards ;  (Pdjwy^^ 
the  ])harynx;  Abscedo,  to  foi-m  an  abscess. — Result  of  acute  or  chronic 
inflammation  of  loose  areolar  tissue  between  posterior  wall  of  pharynx 
and  muscles  on  anterior  part  of  spine.  Often  connected  with  strumous 
diathesis.  Perhaps  may  occur  in  association  with  syphilitic  taint. 
More  common  in  children  than  adults. 

Symptoms.  Derangement  of  cerebral,  respiratory,  and  circulatory 
systems.  Fever,  nausea,  restlessness,  soreness  of  throat.  Difficulty  in 
swallowing  and  breathing.  A  fixed  and  retracted  state  of  head: 
rigidity  of  muscles  at  back  of  neck.  More  or  less  locked  state  of  jaws  : 
painful  and  difficult  and  drawling  articulation.  As  painful  deglutition 
increases,  solids  are  refused  ;  liquids  regurgitate  through  nose.  Spas- 
modic efforts  at  swallowing,  as  if  there  was  food  in  gullet. — On 
examining  fauces,  a  firm  and  projecting  tumor  is  felt  just  beyond  base 
of  tongue. — Death  has  occurred  from  convulsions ;  from  coma  ;  from 
tumor  pressing  pharynx  forwai'ds  on  epiglottis  and  rima  glottidis, 
causing  suffocation  ;  from  abscess  suddenly  bursting,  with  inspiration 
of  pus  into  trachea. 

Treatment.  Puncture  with  a  bistoury  :  head  to  be  pressed  forwards 
directly  opening  is  made  so  as  to  facilitate  escape  of  pus  by  mouth. 
Ammonia  and  bark,  371.  Syi'np  of  phosphate  of  iron,  405.  Quinine, 
379.     Cod-liver  oil.     Nom-ishing  food.     Malt  liquors:  wine. 

RHEUMATISM. — ' Peurj.aTt<T/j.d^,  a  flux  or  looseness;  /^su/iart^o/xai,  to  be 
affected  with  looseness — from  peufj.a,  a  humor  floating  in  the  body  causing 
disease.      There  are  two  forms  of  rheumatism,  the  acute  and  chronic  ; 

1.  Acute  Rheumatism. — Synon.  Rheumatic  Fever;  Synocha  Rheumatica ; 
JIa'nioarfhritis. — A  formidable  disease,  owing  to  the  suffering  it  causes, 
the  intensity  of  the  fever,  and  the  damage  it  so  frequently  inflicts  upon 
the  heart. — A  superabundance  of  lactic  acid  in  the  system  is  the  sup- 
posed cause.  The  suggestion  probably  true,  that  ordinaril}^  the  starch 
of  the  food  is  first  converted  into  lactic  acid  ;  this  then  combines  with 
oxygen  to  form  carbonic  acid  and  w^ater,  which  is  excreted  by  the 
lungs;  but  under  conditions  unfavorable  to  this  oxidation  the  Jactio 
acid  accumulates  in  the  system  (Headland). 

Symptoms.  Restlessness  and  fever,  stiffness  and  aching  pain  in  limbs, 
following  exposure  to  cold  and  damp.  Pain  quickly  increases  ;  swelling 
and  tenderness  of  one  or  more  large  joints:  high  fever  and  constitu- 
tional disturbance.  Patient  soon  rendered  a  pitiable  spectacle  of  help- 
less suflFering.  He  dare  not  move;  pain  in  joints  so  agonizing,  that 
weight  of  bed-clothes  cannot  be  borne  ;  skin' bathed  in  sweat,  of  a  disa- 
greeable acid  or  sour  odor;  pulse,  full,  bounding,  and  quick;  usually 
constipation,  sometimes  diarrhoea;  tongue  moist,  but  thickly  furred;; 
and  urine  high-colored,  acid,  scanty,  loaded  with  urates.  Relapses  very 
common. 


230  RHEUMATISM. 

Complications:  A  tendency  to  metastasis,  the  inflammation  suddenly- 
leaving  one  part  and  reappearing  in  another.  Most  serious  change, 
when  the  pericardium  or  endocardium  becomes  aifected.  Sometimes 
complicated  with  bronchitis,  pleuris}^,  pneumonia,  or  inflammation  of 
brain  and  its  membranes.  Disorganization  of  one  or  more  of  the 
aftected  joints  rarely  occurs. 

When  uncomplicated,  average  duration  from  twelve  or  sixteen  to 
thirty  days.     If  fatal,  this  result  usually  due  to  the  cardiac  affection. 

Treatment.  Venesection  been  recommended,  but  loss  of  blood  is 
badly  borne.  Saline  purgatives,  140,  141,  152,  155,  165,  169.  Calomel 
and  jalap.  Opiates,  in  doses  sufficient  to  relieve  the  pain.  Powder  of 
ipecacuan  and  opium,  213.  Quinine.  Quinine  and  iodide  of  potassium. 
American  hellebore.  Guaiacum.  Liquor  potassae.  Sulphur.  Nitrate 
of  potash,  sometimes  to  extent  of  480  grains  in  24  hours.  Lemon-juice. 
Free  blistering,  excluding  all  drugs  and  other  applications. 

Most  reliable  remedies:  Opium.  Large  doses  of  the  alkalies  and  their 
salts,  as  from  20  to  60  grains  of  bicarbonate  of  potash  or  soda,  in  an 
etlervescing  draught,  every  thi"ee  or  four  hours.  Colchicum,  if  urine 
continue  loaded  with  lithates.  Iodide  of  potassium,  if  disease  remain 
stationar}'  in  one  or  two  joints.  Hot  air  or  vapor  baths,  if  perspiration 
be  scanty.  During  convalescence:  Ammonia  and  bark,  371.  Quinine 
and  iodide  of  iron,  382.  Mild  preparations  of  steel,  390,  391,  394,  401, 
403,  404.     Cod-liver  oil,  389. 

Diet:  At  first  low;  slops  and  arrowroot.  Beef  tea;  milk  and  lime- 
water,  14;  eggs,  cream,  and  beef  extract,  5;  sherry  and  soda  water. 
Light  puddings;  vegetables;  white  fish.  Mutton,  poultry,  and  beef  not 
to  be  allowed  too  soon.    Malt  liquors,  port  wine,  and  sugar  to  be  avoided. 

Local  remedies:  To  lie  between  blankets  in  preference  to  sheets. 
Wrajiping  aff'ected  joints  in  cotton-wool  and  oiled  silk.  Hot  alkaline 
fomentations.  Hemlock  poultices.  Small  blisters  at  a  late  stage.  Iodine 
paint,  205.  If  the  heart  be  irritable,  large  hot  linseed-meal  poultices. 
If  there  be  effusion  into  pericardium,  large  blisters  over  cardiac  region. 
Turpentine  stupes. 

2.  Chronic  Rheumatism. — Synon.  Rheumatismus  Non-febrilis ;  Rheumat- 
algia ;  ArthroJynia. — Sometimes  a  sequel  of  rheumatic  fever,  but  gen- 
erally a  separate  constitutional  affection.  Very  common  in  old  age. 
The  fibrous  textures  around  the  joints,  or  the  fibrous  envelopes  of  the 
nerves,  or  the  aponeurotic  sheaths  of  the  muscles,  or  the  fasciie  and 
tendons,  or  the  peiiosteum  are  the  parts  which  suffer. 

Varieties:  Gonorrhoeal  rheumatism.  Lumbago.  Sciatica.  Stiff  or 
wry  neck.     Pleurodynia. 

Treatment.  Attention  to  the  general  health,  and  to  the  organs  of 
digestion.  Sedatives  to  procure  sleep. — Iodide  of  potassium,  with  tinc- 
ture of  serpentary  or  bark,  31.  Liquor  potassai.  Ammoniated  tincture 
of  guaiac,  43.  Cod-liver  oil,  389.  Quinine,  with  or  without  belladonna, 
45,  386.  Iodide  of  iron,  32.  Ammonia  and  bark,  68,  371.  Oil  of  tur- 
pentine, 50.  Colchicum,  46.  Sarsaparilla,  26.  Corrosive  sublimate,  27. 
Eed  iodide  of  mercury,  54.  Arsenic^  52.  Aconite,  330,  331.  Sulphur, 
43,  148.  Hydrochlorate  of  ammonia,  60.  Tincture  of  actea  racemosa, 
320.  Arnica.  Morphia,  chloroform,  and  Indian  hemp,  317.  Opium  and 
i{)Ocaciianha,  324.     Subcutaneous  injection  of  morphia,  314. 

Sidphurous  waters  of  Hurrogate,  466.  Sea  air,  and  warm  salt  water 
baths.  Alkaline  waters  of  Vichy,  479.  Antacid  springs  of  Carlsbad, 
496.  Hot  air  or  vapor  baths.  Alkaline  baths.  Sulphur  baths. — Vent- 
nor,  434;  Hastings,  432;  Eome,  447 ;  and  Nice,  443,  are  good  winter 
residences  for  habitual  sufferers. 


RHEUMATOID    ARTHRITIS — RIIINORRHCEA.  231 

Locally:  Blisters,  208.  Iodine  paint,  205.  Belladonna  and  aconite 
liniment,  281.  Chloroform  and  opium  liniment,  282.  Veratria  oint- 
ment, 304.  Powdered  sulphur.  Plasters  of  belladonna  or  opium.  Acu- 
puncture. Ironing  the  part,  a  piece  of  brown  paper  being  placed  be- 
tween the  skin  and  hot  iron.  Moxas.  Application  of  a  bladder  of  ice 
for  a  \'ii\v  minutes.     Flannel  next  the  skin. 

RHEUMATOID  ARTHRITIS.— From  'Ftutm,  a  humor  floating  in  the 
body  causing  disease;  eldoz^  appearance;  apOpm^  a  joint,  terminal  -iti^. 
Sjnon.  Rlu'Kniatic  Gout;  Chronic  Rheumnilc  Arthritis;  Nodosity  of  the 
Joints. — A  chronic  inflammatory  affection  of  the  joints,  not  unlike  gout 
in  a  few  of  its  characters,  somewhat  resembling  rheumatism  in  other 
points,  but  differing  essentiall}^  from  both. 

Symptoms.  Pain,  swelling,  and  stiffness  of  affected  joints.  In  acute  . 
cases,  disease  comes  on  abruptly  with  fever  and  general  disturbance; 
but  usually  the  affection  is  chronic,  commencing  with  languor,  restless- 
ness, loss  of  appetite,  and  vitiated  secretions.  The  joints  become  stiff 
and  painful ;  effusion  into  the  synovial  membranes  causes  them  to  ap- 
pear swollen  and  distended ;  and  if  hip,  knee,  or  ankle  be  the  parts 
affected,  there  is  lameness.  Fluctuation  can  sometimes  be  detected  ;  or, 
a  distinct  kind  of  crepitus  may  be  felt.  A  peculiar  crackling  of  the 
joints  on  movement  is  appreciable  to  the  patient.  If  the  disease  be  of 
long  continuance  a  degree  of  rigidity  may  occur  from  thickening  of  the 
articular  textures,  equal  to  that  produced  by  bony  anchylosis;  or  the 
joint  may  become  quite  disorganized  from  a  gradual  wasting  of  the  car- 
tilages. In  addition,  the  articulations  become  deformed;  there  ai'c 
painful  spasms  in  the  muscles  of  the  limbs,  mental  depression,  general 
lassitude,  dyspepsia  with  acidity  of  stomach,  rest  at  night  disturbed, 
every  change  in  the  weather  felt,  while  owing  to  the  languid  circulation 
the  patient  suffers  much  from  cold.  The  complaint  always  lasts  for 
several  months, — sometimes  for  years. 

Treatment.  General  health  to  be  improved.  Uterine  functions  to 
be  regulated.  Generous  diet,  with  animal  food.  Claret,  sherry,  brandy^ 
whiskey,  bitter  ale.  Warm  clothing.  Carriage  exercise.  Sugar,  pastry, 
pickles,  and  cheese  to  be  forbidden. 

Sulphate  and  carbonate  of  magnesia,  141.  Confection  of  sulphur. 
Sulphate  of  soda,  148,  153.  Cod-liver  oil.  Arsenic  with  quinine,  iodide 
of  potassium,  steel,  taraxacum,  and  colchicum,  31,  32,  46,  52,  381. 
Either  of  foregoing  drags  separately,  especially  arsenic.  Lemon-juice.. 
Mineral  acids,  376,  378.  Guaiacum,  43.  Bark  and  serpentary,  375, 
Opium.  Indian  hemp.  Aconite.  Chloroform.  Tincture  of  arnica. 
Leeches.  Blisters.  Mercurial  or  iodine  plasters.  Sulphur,  and  flannel 
bandages.     Aconite  lotions.     Friction,  or  shampooing. 

Sulphur  or  alkaline  baths,  121,  125.  Arsenical  baths,  128.  Vapor  or 
hot  air  baths.  Harrogate  waters,  4G6.  Buxton,  464.  Bath,  460.  Spa, 
467.  Sehwalbach,  488.  Aix-la-Chapelle,  483.  Wiesbaden,  489.  Wild- 
bad,  or  Baden-Baden,  492.     Carlsbad,  496.     Vichy,  479. 

RHINOLITHES. — From  'Ph,  the  nose;  /.idoq,  a  stone. — Concretions 
of  phosphate  and  carbonate  of  lime,  magnesia,  and  mucus,  which  occa- 
sionally form  in  one  of  the  nasal  cavities.  Nucleus  may  consist  of  a 
shell,  piece  of  pencil,  bean,  or  an}'  foreign  hod}'.  Easily  detected  by 
sounding  with  a  probe.     Removal  with  forceps. — See  Ozcena. 

RHINORRHCEA. — From  'Ph,  the  nose;  piw.  to  flow.  Synon.  Bhino- 
blennorrhoea ;  Nasal  Gleet. — Chronic  inflammation  of  the  nostrils,  pro- 
ducinir  a  constant  discharire  of  mucus. — See  Oza'na. 


232  RICKETS RUBEOLA. 

RICKETS. — Synon.  Rachitis;  Osteomalacia  Infantum. — A  disease  pe- 
culiar to  childhood,  as  osteomalacia  is  to  adults.  Usually  appears  to 
commence  about  the  fifteenth  or  eighteenth  month  after  birth,  when 
tlie  child  begins  to  walk.  The  bones  as  they  grow  remain  soft  and 
flexible:  they  bend  under  weight  of  body.  The  osseous  tissue  looks 
natural  in  structure,  but  is  insufficiently  impregnated  with  earthy  salts. 
Strumous  children  of  the  poor  mostly  suffer. 

Symptoms.  Physiognomy  peculiar.  Growth  stunted.  Head  usually 
large;  forehead  prominent;  fontanelles  close  slowly.  Tonsils  often  en- 
larged. Chest  narrow,  with  prominent  sternum — pigeon-breasted.  Spinal 
curvature.  Pelvic  deformity,  so  that  in  after  life  parturition  would  be 
attended  with  great  difficulty.  Curvature  of  the  limbs,  especially  of 
lower  extremities  (bandied  legs).  The  deformed  bones  become  firm 
after  puberty. 

Treatment.  Attention  to  general  habits,  exercise,  and  clothing. 
Animal  food  :  milk  :  raw  eggs.  Phosphate  of  lime.  Phosphate  of  iron. 
Chemical  food,  405.  Cod-liver  oil.  Tannic  acid.  Carrageen,  or  Irish 
moss.  Light  supports  for  spine,  or  lower  limbs.  Bathing  with  salt 
water.     Friction.     Sea  air. 

RODENT  ULCER.— From  Rodo,  to  gnaw.  Synon.  Lupoid  Ulcer; 
Ciincroid ;  Peculiar  Ulcer  of  Eyelids.— Commences  as  a  hard,  irritable, 
and  painful  tubercle.  Ulceration;  the  ulcer  having  hard  margins,  a 
dry  glossy  surface,  and  tubercles  in  or  adjoining  it.  Tendency  to  spread 
slowly  in  every  direction,  completely  destroying  all  adjacent  textures — 
as  muscle,  bone,  eye,  &c.  Most  frequently  situated  on  eyelids;  next,  on 
nose  or  cheeks;  sometimes  seen  on  scalp,  vulva.  Lymphatic  glands 
not  affected.  General  health  often  remarkably  good,  even  when  the 
ulceration  has  produced  frightful  disfigurement.  Occurs  equallj' in  both 
sexes,  after  middle  period  of  life,  ^o  affinity  between  rodent  ulcer  and 
lupus:  former,  more  allied  to  cancer;  latter,  a  skin  disease. 

Treatment.  A  cure  can  be  effected  by  thorough  extirpation  with 
knife  or  caustics, — chloride  of  zinc,  potassa  fusa,  nitric  acid:  in  either 
operation,  anaesthesia  should  generally  be  employed.  Opium.  Cod- 
liver  oil.     Nourishing  food. 

ROSEOLA. — Dimin.  of  Rosa,  a  rose.  Synon.  Rose  Rash;  False  Measles; 
Epidemic  Roseola. — A  non-contagious  inflammatory  affection  of  the  skin. 
One  of  the  Exanthemata.  Characterized  either  by  transient  patches  of 
redness,  of  small  size  and  irregular  form,  distributed  over  more  or  less 
of  surface  of  body;  or  by  formation  of  numerous,  small,  separate,  rose- 
colored  spots.  Accompanied  by  slight  fever.  Occasionally  prevails  as 
an  epidemic.     Duration  from  one  to  seven  days. 

Roseola  sometimes  simulates  measles,  sometimes  scarlatina.  No 
coryza.  Soreness  and  redness  of  fauces,  with  gastric  distui'bance,  often 
present. — Roseola  a?stiva  affects  adults,  especially  women,  in  the  sum- 
mer. May  arise  in  children  from  dentition.  Eruption  often  preceded 
by  chills  and  smart  fever. 

Treatment.  Citrate  of  magnesia.  Sulphate  of  magnesia  Avith  acid 
infusion  of  roses.  142.  Compound  rhubarb  ])owder.  Solution  of  acetate 
of  ammonia  with  spirit  of  nitrous  ether,  348.  Aromatic  sulpluiric  acid 
and  compound  tincture  of  gentian.  Nitric  acid.  Quinine.  Plain  diet. 
Lemonade.  AVarm  baths.  Sponging  with  vinegar  and  water.  During 
teething,  lancing  of  gums  may  be  required. 

RUBEOLA. — From  7?M6eo,  to  blush.     Synon.  Rotheln ;  Scarlatina  Mar- 


RUI'IA SCARLET    FEVEU.  233 

hiUosn;  A  Hybrid  of  Measles  and  Scarlatina. — A  compound  of  measles 
and  scarlet  fever. 

For  treatment,  sec  Scarlet  Fever.  Maintain  functions  of  skin.  Col- 
chicum  has  been  especially  recommended. 

RUPIA.— From  'Putto^,  filth;  owing  to  the  foulness  of  the  affected 
parts.  Synon.  Ulcus  Atonicum ;  Ecpfilysis  Rhypia. — A  non-contagious 
skin  disease.  May  be  regarded  as  a  modification  of  pemphigus  occur- 
ring in  debilitated  constitutions,  and  especially  in  systems  contaminated 
with  poison  of  syphilis.  Characterized  by  eruption  of  flattened  vesicles 
or  bullae;  containing  at  first  serous  fluid,  which  soon  becomes  purulent 
or  sanguinolent,  and  then  concretes  or  dries  into  dark  and  black  and 
rough  scabs.  Margins  of  surrounding  skin  inflame;  serum  continues 
to  be  poured  out;  incrustation  increases  in  circumference  and  thickness 
until  it  somewhat  resembles  the  shell  of  a  limpet.  As  crusts  fall  off 
they  leave  circular  ulcers,  which  often  only  cicatrize  after  lapse  of  man}' 
weeks.  Loins  and  lower  extremities  most  frequently  affected.  Dura- 
tion varies  from  two  or  three  weeks  to  several  months.  Seldom  any 
danger,  unless  a  great  deficiency  of  vital  power  be  present. 

Varieties.  Three  forms  usually  described.  When  crusts  are  thin, 
and  ulcers  beneath  them  superficial. — rupia  simplex.  If  crust  be  large, 
constituting  marked  feature  of  case, — rupia  prominens.  Where  ulcera- 
tion is  extensive  and  deep  and  spreading, — rupia  escharotica. 

Treatment.  Nitric  acid  and  bark,  376.  Quinine  and  mineral  acids, 
379.  Quinine  and  steel,  380.  Cod-liver  oil.  Phosphate  of  iron,  405. 
Bullae  to  be  punctured.  Grenerous  diet:  milk;  wine  or  malt  liquors. 
Warm  baths.  Change  of  air. — In  syphilitic  form:  Iodide  of  potassium 
and  bark,  31.  Iodide  of  iron,  32.  Corrosive  sublimate,  27.  Eed  iodide 
of  mercury,  54.     Mercurial  vapor  baths,  131. 

SAINT  ANTHONY'S  FIRE.— The  popular  name  for  Erysipelas.  St. 
Anthony  of  Padua,  was  supposed  to  work  miraculous  cures  of  this  dis- 
ease.— See  Erysipelas. 

SCABIES. — From  Scabo,  to  scratch.  Synon.  Psora;  Itch;  Scotch 
Fiddle. — A  contagious,  troublesome  skin  disease,  attended  with  great 
itching:  irritation  increased  by  warmth.  Commences  as  a  papular, 
vesicular,  or  pustular  eruption  :  vesicles  or  pustules  ruptured  by  scratch- 
ing, causing  excoriations.  Most  common  about  flexures  of  joints,  espe- 
ciall}'  on  hands. 

Due  to  an  animal  parasite, — the  Acarus  Scabiei,  or  Sarcoptes  Hominis. 
Female  larger  than  male :  after  impregnation  she  burrows  beneath 
epidermis,  forming  furrows  or  cuniculi,  in  which  her  eggs  are  usually 
deposited.     Males  wander  over  surface  of  epidermis. 

Treatment.  Thorough  washing  with  warm  water  and  soft  soap. 
Sulphur  ointment.  Sulphur  baths,  125.  Sulphur  soap.  Lotions  con- 
taining creasote,  carbonic  acid,  corrosive  sublimate,  or  tobacco. — Con- 
taminated clothes  to  be  fumigated  Avith  sulphurous  acid  gas;  or  by 
exposure  to  a  temperature  of  180°  F. ;  or  by  thorough  sprinkling  with 
powdered  sulphur. 

SCARLET  FEVER. — This  disease,  known  also  as  Scarlatina — from 
the  Italian  Scarlatto,  scarlet — is  an  infectious  fever,  characterized  by 
scarlet  efflorescence  of  skin,  and  mucous  membrane  of  fauces  and  ton- 
sils; the  eflflorescence  commencing  about  second  day  of  fever,  and  de- 
clining about  fifth.  Often  accompanied  by  inflammation  of  throat,  and 
sometimes  of  submaxillary  glands.     liike  measles,  essentially  a  disease 


234  SCARLET   FEVER. 

of  childhood;  but  more  to  be  dreaded.  As  a  rule,  scarlet  fever  occurs 
on!}'  once:  in  the  event  of  a  second  attack  there  is  often  no  rash,  little 
or  no  throat  affection,  and  the  disorder  runs  a  favorable  course. 

Three  forms:  Scarlatina  simplex,  in  which  skin  is  most  affected ;  scar- 
latina anginosa,  in  which  both  skin  and  throat  are  severely  implicated; 
and  scarlatina  maligna.,  in  which  all  the  force  of  the  poison  seems  to  be 
expended  upon  the  throat. 

Symptoms.  In  scarlatina  simplex,  after  a  latent  period  of  from  four  to 
six  days,  there  is  fever,  lassitude,  and  headache.  On  second  day,  erup- 
tion appears  in  form  of  nuniberless  minute  dots,  of  a  bright  scarlet  hue. 
This  terminates  by  desquamation  of  the  cuticle:  wliich  begins  about 
the  end  of  fifth  day.  While  the  rash  has  been  appearing,  the  raucous 
membrane  of  mouth,  fauces,  and  tonsils  has  also  been  affected.  Tongue 
covered  with  a  thick  white  fur,  through  which  red  elongated  papilla)  pro- 
ject :  as  the  fur  clears  off,  the  organ  presents  a  strawberry  appearance. 

In  scarlatina  anginosa,  more  violent  symptoms.  Greater  fever,  deli- 
rium, prostration.  The  fauces,  palate,  uvula,  and  tonsils  get  swollen, 
and  covered  with  an  exudation  of  coagulable  lymph.  .The  eruption  is 
delayed  to  third  or  fourth  day,  and  comes  out  in  scattered  patches. 
With  its  fading  on  fifth  or  sixth  day,  the  fever  and  inflammation  of 
throat  begin  to  abate.  Severe  inflammation  of  the  serous  and  mucous 
membranes  to  be  feared. 

In  scarlatina  maligna,  the  fever  assumes  a  malignant  or  t3^phoid  char- 
acter. Great  cerebral  disturbance.  Urgent  prostration.  Low  mut- 
tering delirium.  Dark  incrustations  of  coagulable  lymph,  over  uvula, 
tonsils,  &c.  Cervical  glands  involved.  The  rash  comes  out  late,  disap- 
pears in  a  few^  hours,  and  is  renewed  several  times.  Often  a  fatal  ter- 
mination on  third  or  fourth  day. 

In  all  forms  the  urine  to  be  examined  daily;  as  to  quantity,  reaction, 
and  freedom  from  albumen.  Two  great  sources  of  danger:  suppres- 
sion of  urine  with  uraemia,  and  formation  of  fibrinous  clots  in  right 
cavities  of  heart. 

Sequela?:  Ulceration  and  enlargement  of  tonsils.  Strumous  ulcers. 
Ophthalmia.  Scrofulous  enlargements  of  cervical  glands.  Abscesses  in 
the  ears.  Diseases  of  the  scalp.  Acute  rheumatism.  Cardiac  inflam- 
mation. Scarlatinal  vaginitis.  Anasarca,  dropsy  of  the  serous  cavities, 
and  acute  desquamative  nephritis  with  albuminuria  :  to  be  feared  as 
much  in  mild,  as  in  severe  cases.     Uraemia. 

Treatment.  No  prophylactic  remedy  known.  Acetic  acid,  bella- 
donna, and  inunction  with  oil  or  lard  useless. — The  simpAe  form  only  re- 
quires confinement  to  the  bed-room;  a  warm  bath  or  two;  proper  cloth- 
ing ;  spare  diet;  and  attention  to  the  bowels.  Care  to  be  taken  lest 
the  escape  of  the  poison  by  the  skin  be  checked,  and  thrown  back  upon 
the  kidneys.  Carbonate  of  ammonia,  361.  Acetic  acid ;  or  a  drink  of 
vinegar  and  water.  Sponging  of  skin  with  vinegar  and  water,  138. 
Daily  inunction  of  entire  surface  with  hot  lard. 

Scarlatina  Anginosa :  Emetics  of  ipecacuanha  at  onset.  Saline  effer- 
vescing draughts.  Carbonate  of  ammonia,  3G1,  364,  371.  Cold  or  tepid 
sponging  with  vinegar  and  water.  Cold  affusion,  134.  Inunction  with 
lard.  Scalp  to  be  shaved  and  cold  lotions  apj>lied,  if  there  be  much  de- 
lirium. Good  beef  tea.  Nourishing  soups.  Milk:  cream.  Raw  eggs. 
Port  wine. 

Malignant  Scarlet  Fever:  Demands  stimulants  from  commencement. 
Carbonate  of  ammonia.  Bark.  Port  \yine.  Brand3\  Quinine.  Chlorine, 
77.  Hydrochloric  acid  and  ether,  365.  Ice.  Acid  drinks  ;  or  chlorate 
of  potash  drink,  oGO.     Cold  affusion,  134.     Astringent  gargles,  249,  252, 


SCIATICA — SCLEROTITIS.  235 

254.    Nitrate  of  silver  to  throat.    Essence  of  beef,  3.    Restorative  soup, 
2.     Cream.     Eaw  eggs.     Brandy  and  egg  mixture,  17. 

When  Dropsy  supervenes  :  Compound  jalap  powder.  Elaterium.  Tinc- 
ture of  perchloride  of  iron.  Ammonio-citrate  of  iron.  Quinine.  Min- 
eral acids.    Warm  baths.     Hot  air  or  vapor  baths.     Nourishing  food. 

SCIATICA. — From  '[(T^iov,  the  hip.  Synon.  Neuralgia  Ischiadica ; 
Ischial iji a;  Coxalgia. — Acute  pain  in  sciatic  nerve. — See  Neuralgia; 
Rheumatism. 

SCIRRHUS,  OR  HARD  CANCER.— From  Ixif^i^o^^,  indurat(!d.  Synon. 
Scirrhoma;  Carcinoma  Fibrosiim ;  Fibrous  Cancer.  The  most  frequent 
variety  of  cancer.  Seen  occasionally  in  stomach,  upper  part  of  rectum, 
and  elsewhere;  but  most  frequently  by  far  in  the  female  breast.  Aver- 
age duration  of  life,  after  jjatient's  first  observatjon  of  the  disease,  48 
months. — See  Cancer. 

SCLEREMA. — From  I/.hipb':,  hard  or  stiff.  Synon.  Algide  (Edema 
(from  Algeo,  to  be  cold  ;  and  oiditu,  to  swell). — A  peculiar  disease  of  new- 
born infants,  not  uncommon  in  France  but  rarely  met  with  in  this 
country.  Consists  of  partial  or  universal  induration  of  subcutaneous 
areolar  tissue,  with  serous  effusion. 

Symptoms.  Somewhat  resemble  those  of  ordinary  anasarca.  Ob- 
struction to  circulation, — probably  caused  by  deficient  expansion  of 
extensive  portions  of  lungs  (atelectasis).  Usually  occurs  within  ten 
days  of  birth  ;  mostly  in  feeble  or  premature  children.  The  skin  as- 
sumes a  dry,  stift',  waxy,  yellowish  appearance;  it  gradually  gets  dis- 
tended and  unyielding,  so  that  the  infant  is  said  to  be  skin-bound. 
Temperature  of  body  gets  reduced.  Infant  appears  prostrated,  un- 
healthy, perhaps  jaundiced,  and  as  if  dying  from  exhaustion.  Indica- 
tions of  distress,  restlessness,  whining  cries,  refusal  of  food,  fieeble  pulse, 
laborious  respiration.  Gastric  and  intestinal  disturbance  ajit  to  set 
in.  Death  often  occurs  from  asph^'xia,  within  a  week  from  commence- 
ment of  attack. 

Treatment.  Warm  baths.  Friction  with  warm  flannels.  Body  to 
be  enveloped  in  cotton-wool.  Port  wine  with  a  few  drops  of  tincture 
of  bark.  Ether.  Acupuncture.  Solution  of  raw  beef  in  distilled  water, 
2.  If  child  cannot  suck,  mother's  milk  to  be  drawn  ott'  in  a  spoon  and 
given  frequently.     Goat's  milk.     Cream. 

SCLEROTITIS. — From   Sclerotica,  the  firm  fibrous  tissue  of  the  eye- 
ball ;  terminal  -itis. — Inflammation  of  the  sclerotic  coat  of  the  eye. 
Two  varieties : 

1.  Rheumatic  Ophthalmia. — Synon.  Ophthalmia  Arthritica, — Acute  in- 
flammation of  the  sclerotic  excited  by  cold,  or  by  the  poison  of  rheu- 
matism, or  by  gonorrhoea. 

Symptoms.  Pale  pink  redness  of  the  eye;  the  turgid  vessels  being 
arranged  in  a  radiated  or  zonular  form,  and  being  evidently  beneath 
the  conjunctiva.  Severe  aching  pain  round  the  orbit,  in  the  eyebrow, 
and  over  the  temple,  always  most  severe  at  night.  Occasionally,  intol- 
erance of  light.  Dimness  of  vision,  from  haziness  of  the  cornea  and 
contraction  of  pupil.     Fever  and  constitutional  disturbance. 

Treatment.  Attention  to  diet;  avoiding  port  wine,  beer,  and  sugar. 
Bark  and  iodide  of  ])otassium,  81.  Iodide  of  iron  and  cod-liver  oil,  o'JO. 
Colchicum,  46.  Morphia.  Henbane.  Calomel  and  opium.  Alkaline 
purgatives,  141,  148.     Warm  baths.     Blisters  behind  the  ears  or  to  nape 


236  SCROFULA SCROTAL    CEDEMA. 

of  neck.  Friction  of  forehead  with  belladonna  lininient,  or  with  chloro- 
form liniment.  Application  of  muslin  bags  filled  with  chamomile 
flowers,  and  dipped  in  a  hot  and  strong  decoction  of  poppy-heads. 
Eye-sliades.  Spectacles  with  glasses  of  a  neutral  tint.  Collyria  of 
little  use. 

2.  Catarrho-Rheumatic  Ophthalmia. — Not  an  uncommon  affection : 
characterized  by  a  combination  of  the  symptoms  of  conjunctivitis  and 
sclerotitis. 

Symptoms.  A  feeling  as  of  sand  between  the  ball  and  lids.  Circum- 
orbital  pain.  Scarlet  redness  of  eye,  chemosis,  intolerance  of  light, 
epiphora,  &c.  If  unchecked  ma}'  lead  to  ulceration  of  cornea,  onj'x, 
suppuration  in  anterior  chamber,  efiFusion  of  13'mph  into  pupil.  General 
health  usually  bad. 

Treatment.  Iodide  of  potassium  and  bark,  31.  Opium.  Nourishing 
diet;  milk.  Cod-liver  oil.  Warm  fomentations.  Sedative  collyria. 
Chamomile  bags  dipped  in  decoction  of  poppy-heads. 

SCROFULA. — From  Scrofa,  a  sow;  because  swine  were  supposed  to 
suffer  fi-om  this  disease.  Synon.  Scrophida;  Tabes  Glandularis ;  Struma; 
Kin<fs  Evil. — See  Tuberculosis. 

1.  Scrofulous  or  Strumous  Abscesses. — Often  commence  insidiously  in 
areolar  tissue.  Sometimes  become  indolent.  Suppurate  imperfectly. 
In  other  cases  they  burrow  deeply,  and  in  all  directions.  Long  sinuses, 
from  which  exudes  a  thin  sanious  ]>us.  Occasional  extension  to  the 
bone, — necrosis  resulting.  General  health  much  depressed.  Only  to  be 
cured  by  a  very  nourishing  diet ;  bark ;  iron  ;  cod-liver  oil;  and  sea  air. 
Iodine  and  its  compounds  regarded  as  anti-strumous  remedies.  "Chem- 
ical Food,"  i.  e.,  the  phosphates  of  lime,  iron,  soda,  and  potassa,  in  syrup, 
405.     Anthracite  has  been  recommended. 

2.  Scrofulous  Ulcers. — An  indication  of  the  weak  cachectic  condition 
of  the  strumous  system.  Most  commonly  situated  about  neck,  shoul- 
ders, arms,  or  hips.  Extensive  tracts  of  skin  destroyed  by  their  gradual 
extension.  Efforts  at  repair  slow  and  imperfect.  Granulations  absent, 
or  exuberant  and  flabby:  subjacent  tissue  boggy,  and  readily  broken 
down  by  finger  or  probe.  General  health  bad  from  the  beginning,  with 
daily  deterioration.  Cicatrization  sometimes  procured  after  destruction 
of  the  unhealthy  tissue  with  strong  caustics  :  nitric  acid,  or  potassa  fusa. 
Ordinary  astringent  lotions  useless.  Constitutional  treatment  most  es- 
sential.    Occasionally  strumous  ulcerations  and  lupus  coexist. 

3.  Inflammation  and  Suppuration  of  Lymphatic  Glands. — One  of  the 
most  frequent  results  of  the  strumous  habit.  Glands  of  neck  most  liable. 
Extensive  tracts  of  skin  and  areolar  tissue  sometimes  destroyed.  When 
pus  has  formed,  early  evacuation  by  knife  or  potassa  fusa  required.  The 
resulting  cicatrix  becomes  a  great  disfigurement.  Constitutional  reme- 
dies.— See  Adenitis. 

SCROTAL  ELEPHANTIASIS.— Enormous  hypertrophy  of  the  scro- 
tum. In  many  cases  the  tumor  has  reached  below  the  knees.  Very 
rare  in  temperate  climates.    There  is  no  cure  but  by  removal. — See  Bai'- 

badoes  Leg. 

SCROTAL  (EDEMA.— The  areolar  tissue  of  scrotum  may  rapidly  be- 
come intiltruted  with  serum  as  a  result  of  erysipelas.  Great  constitu- 
tional disturbance:  fatal  sinking  sometimes  occurs  early.  Sloughing 
apt  to  take  place.     Tonics  and  stimulants  must  be  freely  employed. 


SCURVY — SLEEPLESSNESS.  237 

Scrotum  to  be  well  supported   by  8iiuill  pillows.     Fomentations. — See 
Erysiiielas. 

Simple  oedema  of  scrotum  is  usually  an  accompaniment  of  general 
anasarca.     If  it  cause  distress,  relief  may  be  given  by  acujjuncture. 

SCURVY. — Synon.  Scorbutus;  Land  Scurvy ;  Sea  Scurvy. — A  complex 
morbid  state,  caused  b}'  long-continued  privation  of  fresh  succulent 
vegetables  or  fruits,  or  their  preserved  juices. 

Symptoms.  Sallow  dusky  hue  of  countenance,  and  of  skin  generally. 
Swollen,  spongy,  pallid  or  livid  gums.  Fetid  breath.  Debilit}'.  Ilem- 
eralopia.  Deafness.  Dyspnoea.  Sloughing  of  gums.  Loosening  of  the 
teeth.  Hemorrhage  from  gums,  nose,  mouth,  stomach,  intestines.  Ex- 
tensive ecchymoses.  Swelling  and  stiffness  of  legs.  Want  of  energy: 
despondency.  Diarrhoea.  Dysentery.  Dropsy-.  Exhaustion.  Throm- 
bosis. 

Treatment.  Lemon  or  lime  juice.  Oranges.  Salads.  Watercresses. 
Potatoes.  Pickles.  Broccoli.  Cabbage.  Vinegar.  Horseradish. 
Wood  sorrel.  Common  sorrel.  Milk.  Wine  or  beer.  Spruce  beer,  7. 
Fresh  meat  and  fish.  Raw  meat.  Fresh  blood.  Citric  acid.  Iron, 
Catechu.  Gallic  acid.  Tannic  acid  lozenges.  Tartrate,  chlorate,  ni- 
trate, or  phosphate  of  potash.  Opium.  Pure  air.  The  recumbent 
posture. 

SEPTICJEMIA. — From  I-q-nu),  to  putrefy;  aqm,  blood.  Sj^non.  Sep- 
toiima ;  Putrid  Infection. — Contamination  of  the  blood  with  putrefying 
matters — See  Ichorhoimia. 

SIMPLE  CONTINUED  FEVER.— Synon.  FehrlcuJa ;  Ephemera  (when 
only  lasting  a  day). — A  mild  disease,  having  a  variable  duration  of  from 
one  to  ten  days. 

Symptoms.  Patient  suddenly  seized  with  lassitude,  nausea,  anorexia, 
chilliness,  and  pains  in  back  and  limbs.  After  a  few  hours, — heat  of 
skin,  rapid  pulse,  headache,  thirst,  constipation,  and  scanty  ui-ine.  Per- 
haps slight  delirium.  Symptoms  aggravated  at  night.  About  fourth 
day,  or  later,  a  remission ;  critical  sweating,  or  diarrhoea.  Convales- 
cence often  somewhat  slow. 

Treatment.  The  indications  are:  (1)  To  moderate,  when  necessary, 
the  violence  of  artei'ial  excitement  by  saline  laxatives,  rest  in  bed,  and 
low  diet.  (2)  To  support  the  powers  of  the  system,  as  soon  as  they 
begin  to  flag.  (8)  To  obviate  local  inflammations  and  congestions. 
And  (4)  to  relieve  any  urgent  symptoms  if  they  arise. 

SINGULTUS. — From   Singultus,  a  sobbing.     Synon.    Spasmolygmus ; 

Hiccup. — See  Hiccough. 

SLEEPLESSNESS. — Sjmon.  Insomnia  (from  In,  priv. ;  somnus,  sleep); 
Pervigilium  (from  Pervigilo,  to  watch  or  be  awake  all  night). 

Often  a  premonitory  symptom  of  insanity.  Commonly  present  in 
mania,  aggravating  the  symptoms.  Desire  for  sleep  often  banished  in 
the  insane:  sometimes  they  are  afraid  to  sleep  because  of  frightful 
dreams  and  visions.  Sleep  prevented  by  exciting  passions ;  mental 
anxiety;  many  acute  diseases;  dyspepsia;  diseases  ot  heart  and  large 
vessels;  pregnancy;  jaundice,  though  sometimes  where  blood  is  much 
poisoned  there  is  a  tendency  to  excessive  drowsiness.  Medicinal  doses 
of  strychnia,  or  nux  vomica,  will  often  cause  bad  nights. 

Tre.\tment.  Daily  exercise  in  open  air.  A  digestible  diet,  such  as 
will  not  favor  production  of  acidity  or  flatulence.      Avoidance  of  tea 


238  SMALL-POX. 

and  coffee  in  after-part  of  day.  Dinner  at  one  or  two  o'clock  in  the 
afternoon,  with  light  su2:)per  at  night.  Bed-room  to  be  quiet,  well- 
ventilated,  warm.  Bed  to  consist  of  mattress,  without  too  many  heavy 
blankets.  Some  nervous  subjects  can  only  sleep  with  head  quite  low, 
and  lying  on  face  with  arms  folded  underneath. 

When  there  is  debility,  a  tumblerful  of  port-wine  negus,  or  mulled 
claret,  or  white-wine  whey  the  last  thing  at  night.  A  pipe  of  mild 
tobacco  often  unobjectionable. — Where  skin  gets  hot  and  dry,  a 
tumblerful  of  cold  water  or  soda  water  on  going  to  bed.  Eapid 
sponging  of  body  with  tepid  water.  Warm  foot-bath.  A  hot-water 
bottle  in  bed  draws  the  blood  from  brain  to  extremities.  Wet  compress 
over  the  eyes. 

Removal  of  any  physical  cause  for  wakefulness.  Aperignts  if  there 
be  constipation.  Alteratives  and  laxatives  if  stools  be  unhealthy. 
Bismuth,  or  soda,  if  there  be  heartburn  or  acidity.  A  rag  dipped  in 
cold  water,  or  a  tight  band  round  forehead,  if  there  be  headache.  In 
some  acute  diseases,  a  bladder  containing  ice,  to  head. 

Henbane,  325,  337.  Stramonium  and  henbane,  323.  Hop,  &c.,  325. 
Indian  hemp  and  henbane,  337.  Morphia,  chloroform,  and  Indian  hemp, 
317.  Opiate  enemata  or  sujjpositories,  339,  340.  Hypodermic  injection 
of  morphia,  814.  Codeia.  Musk,  with  or  without  assafcetida,  in  hypo- 
chondriasis. When  insomnia  is  due  to  nervous  irritability,  bromide  of 
potassium,  42.     Mesmerism.     Hyjinotism. 

SMALL-POX. — S3mon.  Variola. — A  continued  infectious  fever,  at- 
tended with  an  eruption.  Due  to  absorption  of  a  specific  poison.  The 
disease  would  probabl}'  become  extinct,  were  vaccination  universally 
and  efficiently  performed. 

Symptoms.  This  disease  goes  through  four  stages, — that  of  incuba- 
tion, primary  fever,  eruption,  and  secondary  fever. 

The  period  of  latency  or  incubation  lasts  twelve  days.  Then  there 
is  lassitude,  headache,  fever,  vomiting,  and  well-marked  muscular  pains 
in  back.  These  symptoms  succeeded  at  end  of  48  hours  by  eruption  of 
small  red  pimples,  which  in  course  of  a  week  inflame  and  suppurate. 
In  many  instances  accompanied  by  a  similar  affection  of  mucous  mem- 
brane of  nose  and  mouth  ;  generally  by  soreness  in  throat;  in  some,  by 
swelling  and  inflammation  of  subjacent  areolar  tissue;  occasionally  by 
marked  irritation  of  nervous  system.  When  vomiting  and  pain  of 
back  are  violent,  they  are  generally  precursors  of  a  severe  attack. 

Peculiar  eruption  of  pimples  or  papula;  begins  to  show  itself  on  com- 
mencement of  third  day  of  fever,  appearing  in  following  order;  First 
on  face,  neck,  and  wrists  ;  secondly  on  trunk  ;  and  lastly  on  lower  ex- 
tremities. The  papula;  then  gradually  ripen  into  pustules,  suppuration 
being  complete  by  ninth  day;  at  which  time  pustules  break,  and  crusts 
or  scabs  form.     In  four  or  five  days  more,  these  scabs  are  falling  off. 

The  severity  of  the  disease  bears  a  direct  relation  to  quantity  of 
eruption.  When  pustules  are  few,  they  remain  distinct,  and  separate 
from  each  other;  when  very  numerous,  they  run  together,  coalesce,  and 
lose  their  regularly  circumscribed  circular  fornix  Hence  a  division  of 
small-])ox  into — variola  discreta,  and  variola  C07\fluenB.  Former  seldom 
attended  with  danger;  latter  never  free  from  it.  Eruption  on  face  niay 
be  confluent,  while  it  is  scanty  elsewhere;  still  the  disease  is  of  confluent 
kind.  Sometimes,  pustules  so  numerous  that  they  touch  each  other,  but 
do  not  coalesce ;  disease  then  said  to  be  of  cohering  or  sem.iconfl.utnt 
form.  If,  in  confluent  cases,  symptoms  of  malignancy  and  puti-es- 
ceiicy  are  added,  the  disease  becomes  malignant  small-pox,  a  most  for- 
midable affection. 


SPANiEMIA — SPERMATORRirCEA.  230 

The  greatest  ditlereiiee  between  distinct  and  continent  forms  is  in  l!io 
secondary  fever ;  slightly  marked  in  first,  intense  and  perilous  in  second. 
Sets  in  usually  about  eleventh  day  of  the  disease,  or  eighth  of  eruption, 
and  occasionally  at  once  proves  fatal;  the  system  being  overwhelmed 
by  virulence  of  the  poison.  During  its  course,  troublesome  comijlica- 
tions  may  arise, — as  erysipelas,  swelling  of  glands  in  groin  and  axilla, 
]>hlebitis,  ichorhajmia,  glossitis,  pleurisy,  pneumonia,  ulceration  through 
cornea,  suppuration  of  ear,  conjunctivitis,  &c. 

No  contagion  so  ])Owerful  or  certain  as  that  of  small-pox  ;  infection 
lasts  from  end  of  latent  period  until  every  crust  has  fallen  olf  and  skin 
cicatrized.  One  attack  exhausts  susceptibility  of  system  to  future  influ- 
ence of  the  poison,  as  a  rule.  Variola  occurring  in  ])ersons  unprotected 
by  inoculation  or  vaccination  is  fatal  on  average  to  one  in  evei'y  three. 
When  variolous  matter  is  introduced  into  skin — inoculated  small-pox — 
disease  is  in  all  respects  of  a  mild  nature.  Practice  of  inoculation,  now 
illegal. 

Treatment.  In  simple  cases,  the  less  drugs  are  used  the  better. 
Patient  to  be  kept  quiet  in  bed;  in  a  well-ventilated  room,  free  from 
carpets,  curtains,  &c.  Some  disinfectant  to  be  employed, — iodine  very 
good,  81.  Diet, — arrowroot,  gruel,  weak  beef  tea,  tea  with  milk,  ripe 
fruits.  Lemonade;  barley  water;  plain  water;  raspberry  vinegar 
and  water;  soda  Avater;  ice.  Tepid  sponging.  Change  of  linen  once 
a  day.  Mild  saline  laxatives,  139,  141,  155,  169.  Opium  or  henbane, 
315,  318,  325,  340:  provided  there  be  no  fear  of  mucus  accumulating  in 
the  bronchi  and  threatening  suflfbcation.  Sarracenia  purpurea,  useless. 
Good  broths,  wine,  ether,  bark,  &c.,  when  maturation  of  pustules  pro- 
ceeds tardily.  Complications  to  be  palliated  :  antiphlogistic  remedies 
injurious. 

In  secondary  fever:  Mild  laxatives,  if  necessary:  Effervescent  citrate 
of  magnesia;  compound  rhubarb  powder.  Astringents  if  there  be 
diarrhoea.  Sedatives,  once  or  twice  daily,  if  there  be  restlessness. 
Nourishing  food  :  pounded  meat  in  beef  tea,  good  soup,  milk  or  cream, 
raw  eggs.  Alcoholic  stimulants,  in  proportion  to  the  depression. — If 
any  boils  or  abscesses  form,  early  incision. 

For  sloughy  and  gangrenous  sores:  Quinine,  379.  Bark  and  nitric  acid, 
376.     Ale,  wine,  or  brandy.     Milk:  pounded  beef.     Water  bed. 

To  prevent  pitting :  Olive  oil.  Glycei'ine  and  rose-water  (equal  parts). 
Lime  liniment.  Nitrate  of  silver.  Puncturing  the  pustules.  Collodion. 
Gutta  pereha  and  collodion.  Mercurial  ointment.  Tincture  of  iodine. 
Sul])hur.  Linseed  or  yeast  poultices.  Water  dressing.  Oxide  of  zinc 
ointment. 

SPANJEMIA. — From  Ir.a'^q.  thin  or  poor;  al/jta,  blood.  Thin  or  poor 
blood:  A  diminution  in  the  quantity  of  red  corpuscles. — See  Anaemia. 

SPERMATORRH(EA.— From  JTr.V",  seed;  piu>,  to  flow.  Synon. 
Spermorrhcea ;  Gonorrhoea  Vera;  Profluviuni  Seminis ;  Pollution. — A 
deranged  state  of  mental  and  bodily  health,  due  to  the  too  frequent 
escape  of  seminal  fluid.     Masturbation  the  most  common  cause. 

Symptoms.  There  may  be  only  a  repeated  escape  of  seminal  fluid; 
or  this  may  be  associated  with  morbid  changes  in  vesicular  seminales, 
ejaculator^*  ducts,  bulbous  portion  of  urethra,  and  prostate  gland.  Urine 
sometimes  rendered  slightly  albuminous  by  seminal  fluid. 

General  weakness:  nervous  irritability,  with  a  dreamy  absent  kind 
of  manner.  Flatulence  and  constipation.  Dulness  of  sight  and  perhaps 
of  hearing.  Weakness  of  memorj-.  Attacks  of  palpitation,  giddiness, 
headache,  neuralgia.  In  extreme  cases,  final  result  may  be  epilepsy, 
phthisis,  impotence,  insanity. 


240  SPINA    BIFIDA SPINAL    CURVATURE. 

Treatment.  General  rules:  Moderate  mental  and  bodily  work. 
Cheerful  society.  Not  more  than  eight  hours  for  sleep,  on  a  mattress, 
without  too  much  clothing.  Obscene  works  of  quack  doctors  and  sham 
museums,  to  be  shunned  like  virulent  poisons.  Avoidance  of  heavy 
meals,  alcoholic  drinks,  and  tobacco:  substitution  of  milk  for  tea  and 
coffee.  If  emissions  take  place  when  patient  lies  on  his  back,  a  cotton- 
reel  to  be  tied  over  middle  of  spine  at  night.  Salt  water  sponge  baths, 
tepid  or  cold,  with  friction  of  skin.  Careful  ablution  of  glans  penis  to 
remove  irritating  secretions  of  sebaceous  follicles.  Support  of  testicles 
by  suspensory  bandage. 

Drugs :  Phosphoric  acid,  nux  vomica,  and  bark,  376.  Sulphate  of 
zinc  and  nux  vomica,  409.  Phosphate  of  zinc.  Quinine  and  iron,  380  : 
best  avoided  in  single  men,  as  all  ferruginous  tonics  produce  congestion 
of  sexual  organs  Cod-liver  oil.  Bromide  of  potassium.  Camphor,  co- 
nium,  and  belladonna,  326.  Digitalis.  Ergot  of  rye.  Cubebs. — Re- 
moval, when  present,  of  oxyurides  from  rectum  ;  or  of  excessive  acidity 
of  urine. 

Local  treatment :  Only  required  in  exceptional  cases.  Introduction  of 
metallic  sound  into  bladder,  once  or  twice  a  week.  Nitrate  of  silver  to 
prostatic  portion  of  urethra, — Lallemand's  porte  caustique.  Circumci- 
sion.    Galvanism. 

SPINA  BIFIDA. — Synon.  Hydrorachitis,  from  "T8(op,  water,  and  pciyt,;^ 
the  spine ;  Hydrorachis  Congenita ;  Cleft  Spine. — A  congenital  deficiency  of 
the  posterior  laminsB  and  spinous  process  of  one  or  more  vertebraj ; 
owing  to  which  there  is  undue  distension  of  membranes  of  cord  with 
cerebro-spinal  fluid.  May  exist  in  cervical,  doi'sal,  lumbar,  or  sacral 
region  :   most  common  in  lumbar. 

Symptoms.  A  tumor  is  formed,  varying  in  size  fi"om  a  walnut  to  a 
child's  head.  There  is  fluctuation:  swelling  most  tense  when  child  is 
held  upright:  swelling  semi-transparent:  skin  may  be  unaffected,  or 
congested  and  blue.  Prognosis  unfavorable,  if  complicated  with  hydro- 
cephalus; if  there  be  paralysis  of  bladder  or  rectum  and  lower  extremi- 
ties; if  the  tumor  threaten  to  burst  by  increasing  in  size.  When  only 
two  or  three  upper  lumbar  vertebrae  are  aftected,  the  spinal  cord  seldom 
deviates  from  its  course,  and  only  the  posterior  spinal  nerves  have  any 
connection  with  the  sac.  If  tumor  occupy  part  of  lumbar  and  part  of 
sacral  region,  the  cord  itself  and  its  nerves  will  almost  always  be  found 
in  close  contact  with  the  sac.     The  disease  is  not  necessarily  fjxtal. 

Treatment.  If  general  health  be  good,  and  tumor  small,  interference 
will  be  unnecessary,  beyond  protecting  the  growth  bj- a  piece  of  leather 
or  gutta  percha  moulded  to  the  part.  Where  there  is  slow  enlargement 
pressure  may  be  tried  by  an  air  pad,  or  by  painting  with  coUodium. 
Where  growth  is  rapid,  and  there  is  a  fear  of  skin  giving  wa}^,  tapping 
with  a  small  trocar  may  defer  a  fatal  result:  after  emptying  the  sac, 
pressure  to  be  a2)plied.  Iodine  injections  have  succeeded  twice  at  least: 
their  employment  fraught  with  danger.  In  another  case,  a  cure  was 
effected  by  application  of  a  clamp  to  the  broad  base,  the  instrument  be- 
ing gradually  tightened  until  the  tumor  sloughed  off. 

SPINAL  CURVATURE. — The  causes  of  spinal  curvature  are :  Peculiar 

avocations,  causing  the  muscles  on  one  side  to  become  unduly  developed 
and  powerful:  e.  g.,  habitual  use  of  right  arm  in  blacksmiths.  Constant 
assumption  of  an  unnatural  attitude:  e.  g.,  nurses  carrying  children 
always  on  one  arm  ;  repeatedh'  standing  on  right  leg  with  left  knee 
somewhat  bent.  General  weakness,  producing  a  relaxed  and  flabby 
state  of  all  the  tissues;  or  a  deficiency  of  earthy  matters  in  the  osseous 


SPINAL    CURVATURE.  2-11 

system,  so  that  there  results  a,  loss  of  equilibrium  between  the  resist- 
ance of  spinal  column  and  weight  of  u])|)ci'  part  of  body:  e.  g.,  curva- 
ture from  rickets,  and  destruction  of  the  bodies  of  the  vertebra)  by 
caries. — There  are  three  principal  varieties  :  Lateral  Curvature,  the  con- 
vexity being  to  either  side,  but  usually  to  the  right.  Posterior  curva- 
ture^ or  excurvation.     And  anterior  curvature,  or  incurvation. 

1.  Lateral  Curvature. — The  most  common  form.  Appears  chiefly  in 
young  women  between  the  ages  of  ten  and  eighteen  ;  who  are  said  to 
outgrow  their  strength,  i  e.,  the  wants  of  the  S3'Stem  are  insufficiently  sup- 
plied owing  to  imperfect  assimilation  of  food,  too  little  outdoor  exercise, 
and  inattention  to  position  while  standing  or  walking. 

Symptoms.  One  shoulder  observed  to  be  higher  than  the  other :  or 
a  growing  out  of  one  scapula.  While  one  shoulder  is  high,  the  other  is 
unduly  depressed.  So  one  hip  projects,  while  the  opposite  curves  in- 
wards. On  examination  the  vertebi*al  column  is  found  to  be  curved: 
in  double  lateral  curvature  it  is  twisted  like  the  italic/.  As  the  tlioi-acic 
and  abdominal  cavities  are  more  or  less  deformed,  the  pla}'  and  tree 
movements  of  the  viscera  get  impeded.  If  there  be  difficulty  in  taking 
full  inspirations,  dj'spnoea  will  be  present.  The  action  of  the  muscles  of 
trunk  is  impaired.  General  health  suffers.  Pain,  from  pressure  exei-ted 
on  the  nerves.  In  curvature  from  rickets  there  is  also  distortion  of  the 
limbs:  patient's  aspect  rickety. 

Treatment.  Maintenance  of  general  health  at  highest  point  of 
efficiency.  Animal  food:  milk;  raw  eggs.  Cod-liver  oil.  Sea  air.  and 
baths.  Quinine  and  ii'on,  380,  382.  Phosphate  of  iron  ;  chemical  food, 
405.  Strengthening  of  muscles  and  ligaments  which  act  on  vertebi-a), 
by  frictions,  palpation,  shampooing.  Carefully  devised  gymnastic  ex- 
ercises. Removal  from  spinal  column,  by  proper  apparatus,  of  such 
weights  or  forces  as  tend  to  keejD  the  various  segments  of  spine  in  an 
unnatural  relation  to  one  another. 

2.  Posterior  Curvature. — Chiefly  affects  the  cervical  and  dorsal  re- 
gions. May  be  caused  in  infancy  by  the  frequent  practice  of  raising  the 
child  by  placing  the  hands  under  the  armpits,  and  so  compressing  the 
ribs  and  forcing  back  the  sternum  and  spine.  The  muscles  and  liga- 
ments which  keep  the  column  erect,  become  relaxed.  In  rare  cases, 
there  is  disease  of  bodies  of  vertebra). 

3.  Anterior  Curvature. — Synon.  Angular  Curvature;  Pott's  Curvature. — 
The  most  uncommon  variety.  Generall}"  associated  with  some  consti- 
tutional affection  (scrofula);  producing  caries  or  ulcerative  destruction 
of  bodi(^s  of  vertebrn3,  or  interstitial  softening  and  absorption  of  cal- 
careous elements  of  osseous  texture.  As  many  as  tive  or  six  vertebi"», 
with  the  intervertebral  substances,  may  be  affected.  More  frequent 
about  mid-dorsal  region  than  elsewhere. 

Symptoms.  General  indications  of  scrofula.  "Weakness,  coldness,  and 
numbness  of  legs.  Twitchings  and  spasms  of  legs.  Subsequently  pa- 
ralysis of  bladder,  rectum,  and  lower  extremities.  Tenderness  or  dull 
aching  pains,  in  back.  Tightness  of  chest,  with  more  or  less  dyspnoea. 
Occasionally,  formation  of  strumous  abscesses.  Exhaustion  and  hectic. 
Under  favorable  circumstances,  disease  gets  arrested;  bones  collapse, 
anchjdosis  occurs,  and  pus  becomes  absorbed;  patient  recovering,  but 
with  incurable  deformity.  Sometimes  sudden  death;  owing  to  diseased 
bodies  of  vertebrae  giving  way  and  crushing  spinal  cord,  or  from  occur- 
rence of  dislocation  of  odontoid  process  of  axis  in  consequence  of  ulcer- 
ation and  destruction  of  its  ligament. 

16 


242  SPINAL    HEMORRHAGE — SPINAL    MENINGITIS. 

Treatment.  Perfect  rest  in  horizontal  position  is  indispensable.  Use 
of  a  reclining  couch,  so  shaped  as  to  keep  the  trunk  perfectly  quiet.  A 
stitf  bandage,  or  pair  of  stays,  extending  from  occiput  to  hips,  to  insure 
rest.  Any  active  attempts  to  remove  deformity  will  altogether  prevent 
a  cure  of  the  disease.  Pain  to  be  relieved  by  belladonna  or  opium 
plasters  :  issues,  setons,  blisters,  or  leeches  worse  than  unnecessary. 
Abscesses  to  be  opened  when  they  point.  Improvement  of  general 
health,  by  good  diet,  cod-liver  oil,  phosphate  of  lime,  bark,  or  steel. 
During  convalescence,  mechanical  support  to  the  trunk  judiciously  ap- 
plied. 

SPINAL  HEMORRHAGE.— Synon.  Myelorrhagia;  Myelapoplexia ; 
Apoplexia  Myelitica ;  Apoplexy  of  the  Cord;  Paralysis  from  Effusion  of 
Blood  into  Spinal  Canal  or  into  Substance  of  Cord. — More  rare  than  cere- 
bi'al  hemorrhage.  Arises  from  injury;  acute  inflammation  of  cord  or 
membranes;  fatty  degeneration  of  coats  of  vessels ;  caries  and  other 
disease  of  vertebras. — Blood  poured  out  external  to  dura  mater;  or  be- 
tween membranes ;  or  into  gray  portion  of  cord.  Death  may  happen 
at  once;  or  after  a  variable  interval  from  chronic  softening  of  nervous 
substance. 

Symptoms.  Yixry  according  to  seat  of  ruptured  vessels.  Blood  effused 
between  the  membranes,  gi-avitates  to  lowest  part  of  spinal  canal :  hence, 
paralysis  which  gradually  extends  upwards.  Acute  and  sudden  pain  in 
back,  sometimes  in  head.  Often,  severe  convulsions.  Difficult  breathing 
when  there  is  pressure  on  upper  part  of  cord.  Heart's  action  depressed. 
Surface  pale  and  cold.  Consciousness  unimpaired. — Effusion  into  sub- 
stance of  cord  produces  sudden  paralysis  in  all  parts  supplied  with 
nerves  below  its  seat :  where  hemorrhage  is  very  slight,  loss  of  power 
occurs  slowly  after  lapse  of  some  hours. 

Treatment.  Further  effusion  to  be  checked  by  perfect  repose:  appli- 
cation of  ice  along  spinal  column.  Aconite,  to  moderate  heart's  action 
if  it  be  excited. 

SPINAL  IRRITATION. — Synon.  Rhachialgia ;  Neuralgia  Spinalis; 
Notalgia. — Probably  no  disease  exists  deserving  this  name.  The  symp- 
toms mostly  observed  in  women :  pains  about  mamma?,  thorax,  abdo- 
men, or  uterus.  Tenderness  on  pressure  over  spinous  processes  of  cer- 
tain vertebrae.  The  suffering  due  to  a  combination  of  myalgia  and 
hysteria,  with  constitutional  weakness.  This  opinion  confirmed  by 
curative  influence  of  belladonna  plasters;  nourishing  food;  cod-liver  oil; 
bark  or  steel ;  sea  air ;  and  moderate  exercise. 

SPINAL  MENINGITIS.— From  Spina,  the  backbone;  Mfivty^,  a  mem- 
brane; terminal -«Yis. — Synon.  Perimyelitis;  Myelomeningitis;  Acute  Pa- 
ralysis from  Inflammation  of  Membranes  of  Spinal  Cord. — Acute  inflam- 
mation of  membranes  of  cord  not  a  common  disease.  It  terminates  in 
resolution,  effusion  of  serum,  softening  of  cord,  or  suppuration.  When 
acute,  may  be  associated  with  disease  of  cerebellum  or  of  cerebral  mem- 
branes ;  when  chronic,  mostly  connected  with  caries  of  vertebrae.  Me- 
chanical injuries,  and  exposure  to  wet  and  cold  in  rheumatic  subjects, 
the  most  frequent  causes. 

Symptoms.  High  fever  and  sleeplessness.  Acute  burning  pains  along 
spine,  extending  into  limbs;  greatly  aggravated  by  motion  and  pres- 
sure; often  simulating  rheumatism.  Eigidity,  or  tetanic  contraction  of 
muscles  of  neck  and  back.  Feebleness  of  limbs,  perhaps  to  extent  of 
paralysis  of  lower  extremities:  loss  of  power  extends  upwards  as 
effused  serum  increases  in  quantity.     Suffocating  sensations  :  feeling  of 


SPINAL   TUMORS — SPIROMETRY.  243 

constriction  in  neck,  back,  and  abdomen.  Eetention  of  urine.  Priapism. 
Obstinate  constipation,  sometimes  succeeded  by  diarrhoea.  Great  pros- 
tration, if  morbid  action  proceed:  sometimes,  feverish  delirium  and 
coma. 

Cerebro-S'pinal  meningitis  occasionally  occurs  as  an  epidemic  :  inmates 
of  workliouses,  soldiers  in  over-crowded  barracks,  liable  to  it. 

Treatment.  Iodide  of  potassium  and  aconite,  31.  Corrosive  subli- 
mate and  sarsaparilla,  27.  Eed  iodide  of  mercury,  54.  Aconite  and 
guaiacum,  330.  Stramonium.  Henbane.  Belladonna.  Castor^  oil. 
Calomel  and  jalap  — Locally :  Lint,  saturated  with  belladonna  or  aconite 
liniment,  and  oiled  silk.  Linseed  poultices.  Fomentations  with  poppy- 
heads  and  chamomile  flowers.  Ice?  Blisters.  Tartarated  antimony 
ointment.     Painting  of  spine  with  diluted  iodine  liniment.     Leeches. 

To  prevent  the  spread  of  epidemic  cerebro-spinal  meningitis,  removal 
from  unhealthy  locality  is  necessary. 

SPINAL  TUMORS. — Paralysis  may  arise  from  long-continued  pres- 
sure of  tumors  on  the  cord,  producing  partial  atrophy.  Morbid  growths 
consist  of  tubercle,  cancer,  bone,  or  hydatid  cysts.  Exostosis  of  odon- 
toid process  of  second  cervical  vertebra,  an  occasional  cause.  Some- 
times, tumor  has  its  origin  in  syphilitic  disease  of  vertebra;. 

Symptom-s.  Come  on  slowly.  Paralysis  often  not  manifested  until 
great  pressure  is  exerted.  Paralysis  of  motion  always  precedes  that  of 
sensation.  Pain  over  seat  of  growth.  Cramps,  and  convulsive  move- 
ments of  extremities.  Systemic  disease  where  tumor  is  of  a  tubercular, 
cancerous,  or  syphilitic  nature. 

Treatment.  Iodide  of  potassium.  Iodide  of  ammonium.  Red  iodide 
of  mercury.  Corrosive  sublimate.  Syrup  of  iodide  of  iron.  Cod-liver 
oil.  Nourishing  food  :  milk.  Counter-irritants  to  painful  parts  of  spine, 
occasionally  useful. 

SPIROMETRY. — From  Spiro,  to  breathe;  fierpico,  to  measure.  The 
mode  of  measuring  the  quantity  of  air  which  the  lungs  can  contain. 

Spirometers,  or  Spiroscopes,  or  Pneumometers,  are  instruments  for 
measuring  the  volume  of  air  expired  from  the  lungs.  This  volume  is 
diminished  in  each  stage  of  phthisis.  Quantity  of  air  expired  after 
most  complete  inspiration  is  the  vital  volume  or  vital  capacity.  The 
vital  capacity  always  increases  with  stature ;  also  slightly  affected  by 
weight,  but  not  sufficiently  to  interfere  with  correctness  of  following 
table,  which  shows  the  capacity  in  health  and  in  the  three  stages  of 
phthisis : 

Height. 


Ft. 

in. 

Ft. 

in 

5 

0 

to  5 

1 

5 

1 

"   5 

2 

6 

2 

"   5 

3 

6 

3 

"   5 

4 

5 

4 

"   5 

5 

5 

5 

"   5 

6 

5 

6 

"   5 

7 

5 

7 

"   5 

8 

6 

8 

"   5 

9 

5 

9 

"  5 

10 

5 

10 

"   5 

11 

5 

11 

"  6 

0 

Capacity  in 
Health. 

Cub.  in. 
.   174  .     . 

Capac 

Ist  Stage. 

Cub.  in. 

.      .    117   .      . 

ity  in  Phthisis  Pu, 

2d  Stage. 

Cub.  in. 

.     .     99  .     . 

Imonalis. 

3(1  Stfige. 
Cub.  in. 

.     .     82 

.   182  .     . 

.     .  122  .     . 

.     .  102  .     . 

.     .     86 

.   190  .     . 

.     .  127  .     . 

.     .  108  .     . 

.     .     89 

.   198  .     . 

.     .   133  .     . 

.     .   113  .     . 

.     .     93 

.  206  .     . 

.     .  138  .     . 

.     .  117  .     . 

.     .     97 

.  214  .     . 

.     .  143  .     . 

.     .  122  .     . 

.     .  100 

.  222  .     . 

.     .  149  .     . 

.     .  127  .     . 

.     .  104 

.  280  .     . 

.     .  154  .     . 

.     .  131  .     . 

.     .  108 

.  238  .     . 

.     .  159  .     . 

.     .   136  .     . 

.     .  112 

.  246  .     . 

.     .   165  .     . 

.     .  140  .     . 

.     .   116 

.  254  .     . 

.     .  170  .     . 

.     .  145  .     . 

.     .  119 

.  262  .     . 

.     .  176  .     . 

.     .   149  .     . 

.     .  123 

This  table  reads :  A  man  whose  height  is  between  5  ft.  7  in.  and  5  ft. 
8  in.  should  breathe  in  health  230  cubic  inches:  in  first  stage  of  con- 


244  SPLENIC    DISEASE — STOMATITIS. 

sumption  this  is  reduced  to  154 ;    in  second,  to  131 ;  in  third,  to  108 
cubic  inches. 

To  test  the  vital  capacity  the  patient  loosens  his  vest,  stands  per- 
fectly' erect,  takes  as  deep  an  inspiration  as  possible,  and  places  mouth- 
piece of  spirometer  between  his  lips.  The  observer  having  opened  the 
tap,  ]'»ationt  empties  his  lungs,  steadily  making  deepest  possible  expira- 
tion ;  at  termination  of  which  the  operator  turns  off  the  tap,  thus  con- 
fining the  air  in  receiver.  Tiie  receiver  is  then  to  be  lightly  depressed 
until  the  surfaces  of  spirit  in  bent  tube  on  outside  of  insti'ument  are 
on  a  level  with  each  other,  when  the  vital  capacity  may  be  read  off 
from  scale. 

SPLENIC  DISEASE.— The  spleen,  like  other  glands,  is  liable  to, — 
Congestion,  inflammation,  softening,  abscess,  gangrene  ;  tubercular  and 
malignant  disease;  fibrinous  deposits — remains  probably  of  extrava- 
sated  blood;  serous  and  hydatid  cj'Sts ;  and  simple  enlargement. — 
More  common  among  residents  of  tropical  and  marshy  than  of  tem- 
perate climates. 

Enlargement  of  Spleen  ("Ague-cake")  generally  results  from  repeated 
attacks  of  intermittent  fever.  Sufferers  from  it  have  a  peculiar  sallow 
and  unhealthy  aspect;  anaemic  appearance  of  gums  and  buccal  mucous 
membrane;  tendency  to  hemorrhage;  dyspepsia;  debility  and  loss  of 
flesh.  Wlien  result  of  ague, — aperients;  bark  or  quinine  ;  arsenic.  In 
other  forms, — steel;  bromide  of  potassium.  Friction  with  diluted  oint- 
ment of  red  iodide  of  mercury.  Good  nourishing  food.  Residence  in  a 
dry  and  bracing  locality.  Avoidance  of  mercury  and  depletion.  Iodine, 
iodide  of  lead,  nitric  acid,  ergot  of  rye,  have  been  emplo3'ed.  Rusot 
(an  extract  prepared  by  natives  of  India  from  the  Berberis  Lj'cium 
and  Berberis  Aristata)  has  been  strongly  recommended.  Extirpation 
of  the  spleen  (Splenectomy)  has  been  resorted  to. 

STOMATITIS. — From  lT6>ia,  a  mouth  ;. terminal  -His.  Inflammation 
of  the  mouth. — A  common  disease  of  young  children.  It  may  occur  in 
three  forms, — i.e.,  according  as  chief  seat  of  morbid  action  is  in  mucous 
follicles  of  mouth,  substance  of  gum,  or  in  tissues  of  cheek. 

1.  Follicular  Stomatitis. — Inflammation  of  mucous  follicles  of  mouth 
may  be  idiopathic,  or  a  sequela  of  one  of  the  eruptive  fevers. 

SvMPTOMS.  Difticulty  of  sucking.  Abundant  flow  of  saliva.  Sub- 
maxillary glands  tumid  and  tender.  Restlessness,  with  fever.  Loss  of 
appetite.  i)iarrhoea  with  offensive  motions.  Small  vesicles  on  inside 
of  mouth,  on  tongue  and  fauces:  vesicles  burst  and  form  ulcers,  which 
are  covei-ed  with  dirty  white  or  yellowish  sloughs. 

Treatment.  Application,  with  a  camel's-hair  pencil,  of  borax  and 
glycerine,  250.  Mild  tonics.  Carbonate  of  magnesia.  Chlorate  of  pot- 
ash.    Attention  to  the  milk  supplied  to  child.     Beef  tea. 

2.  Ulcerative  Stomatitis. — Synon.  Noma,  from  Niiim,  to  con-ode. — 
Ulceration  of  the  gums,  sometimes  destroying  these  parts  and  denuding 
the  teetii.  Occurs  mostly  in  badly  nourished  children.  May  be  er- 
roneously atti'ibuted  to  use  of  mercury. 

SvMPT(tMS.  Heat  of  mouth.  Salivation.  Offensive  breath.  Swelling 
of  upper  lip  :  enlargement  and  tenderness  of  subn\axillary  glands.  Gums 
get  swollen,  red  or  violet  colored,  and  covered  with  a  layer  of  pulpy 
grayish  matter.  If  disease  proceed,  gums  become  destroyed  by  the  ul- 
cei'ation  :  teeth  are  exposed  and  loosened.  Inside  of  cheeks  may  be  in- 
volved: irregular  sloughing  ulcerations. 

TreaTiMENT.      Chlorate  of  potash :  gr.  5  may  be  given   every  four 


STOMATORRHAGIA — SUDAMINA.  245 

hours  in  sweet  tea  to  an  infant  one  year  old.  Subsequently,  bark  in 
wine.  Cod-liver  oil.  Pure  milk;  that  of  the  ass,  goat,  or  cow.  .Solu- 
tion of  raw  meat,  2.     Beef  tea,  6. 

3.  Gangrenous  Stomatitis. — Synon.  Cancrum  Oris;  Sloxighing  Phage- 
dirna  of  Movth. — A  formidable  disease.  Occurs  in  weakly  children,  be- 
tween second  and  fifth  year. 

Symptoms.  Debility.  A  hard  indolent  swelling  on  one  check.  On 
examining  mouth,  a  whitish  or  ash-colored  eschar  is  seen  in  centre  of 
cheek:  slough  increases  until  it  si:)reads  over  whole  of  inside  of  cheek, 
lips,  and  gums.  Saliva  copious  :  horribly  fetid.  Great  constitutional  dis- 
tiirl)ance.  Pulmonary  complications  apt  to  occur.  Frequently,  death. — 
Often  attributed  to  use  of  mercury:  ma}'  occur  where  none  has  been 
given. 

TKEATArENT.  Application  of  nitrate  of  silver,  sometimes  of  strong 
nitric  acid  to  slough.  Frequent  syringing  of  mouth  with  warm  water: 
with  sohition  of  permanganate  of  potash.  78:  with  chlorinated  soda 
gargle,  254.  Chlorate  of  i)ota8h  in  bai'k.  Wine,  or  brand}'.  Eaw  meat, 
2.     Milk:  cream. 

STOMATORRHAGIA.— From  Izotm,  a  mouth ;  piiyvutu,  to  break  out. 

Synon.  Stomatorrha'a ;  Jlcemorrhagia  Oris;  Buccal  Heworrhage. — Dis- 
charges of  blood  from  mouth  and  throat  seldom  give  trouble,  except 
when  they  occur  during  last  stages  of  scurvy  or  purpura,  or  after  ex- 
cessive use  of  mercury.  In  some  instances,  small  veins  about  mouth 
and  pharynx  become  varicose;  should  their  walls  rupture,  severe  or 
fatal  bleeding  may  result.  Ulcers  about  tongue  seldom  bleed  much. 
Gangrenous  glossitis  has  ended  fatally  with  hemorrhage. 

Treatment.     Ice.     Cold  astringent  washes. — See  Hemorrhage. 

STROPHULUS.— Synon.  Li cheniasis Strophulus;  Tooth-rash;  Bed  Gum 
Bash. — A  papular  skin  disease,  peculiar  to  infants  and  young  children. 
Characterized  by  an  eruption  of  minute,  hard,  sometimes  slightly  red, 
and  clustered  or  scattered,  pimples.  May  appear  upon  a  part,  or  ex- 
tend over  whole  sui'face  of  body.     Irritation  slight. 

Varieties.  Several  described,  according  as  j^apulse  ai'e  large  or  small, 
scattered  or  grouped.  But  whether  papules  are  scattered,  with  red  dots 
interspersed  among  them,  as  in  strophulus  intertinctus ;  or  white  and 
large,  often  resembling  flea-bites,  as  in  strophidus  candid  us ;  or  forming 
circular  patches,  which  come  out  successively  in  ditferent  parts  of  body, 
as  in  strophulus  volaticus.^ — is  of  little  moment.  Practically,  all  forms 
due  to  stomach  or  intestinal  derangement;  the  consequence  of  imj)roper 
feeding,  or  of  irritation  about  gums  from  dentition. 

Treatment.  Careful  diet.  Avoidance  of  acid  milk  Mild  antacid 
aperients.  Weak  glycerine  lotions.  Lancing  gums,  in  strophulus  con- 
nected with  ditficult  dentition. 

STYES. — A  stye  or  hordeolum  (from  Hordeum,  barley)  is  merely  a 
small  boil,  of  the  size  and  firmness  of  a  barleycorn,  situated  at  the  edge 
of  the  eyelid. — See  Boils. 

SUDAMINA. — From  Sudo,  to  sweat.  Synon.  Hydroata ;  Papido'  Su- 
dorales;  Sweat  Vesicles. — Consist  of  crops  of  small  transparent  vesicles, 
which  come  out  in  many  diseases  attended  with  sweating.  The  skin 
looks  as  if  dotted  with  small  colorless  glass  beads.  Most  common  on 
front  of  neck  and  chest.     No  treatment  required. — See  Miliaria. 


246         SUPRA-RENAL   CAPSULAR   DISEASE — SUSPENDED   ANIMATION. 

SUPRA-RENAL  CAPSULAR  DISEASE.— Synon.  Iforbus  Addisonii; 
Supra-renal  Melasma. — An  excessive  degree  of  anaemia,  supposed  to  be 
due  to  disease  of  the  supra-renal  capsules. 

Symptoms.  Commence  very  gradually :  failing  health  and  debility. 
Languor;  loss  of  appetite;  feeble  pulse;  irritability  of  stomach;  pro- 
gressive emaciation.  Perhaps  vomiting  and  gastric  irritation  ;  indica- 
tions of  disturbed  cerebral  circulation.  A  gradual  discoloration  of  skin ; 
most  marked  about  face,  neck,  arms,  circumference  of  navel;  gradually 
becoming  of  a  dingy  or  smoky  hue.  This  discoloration  now  said  (con- 
trary to  Addison's  original  views)  not  to  be  a  necessary  element :  ap- 
pears only  when  case  has  been  of  long  duration,  and  perhaps  not  then. — 
After  an  average  duration  of  eighteen  months,  death  from  extreme 
anaemia  and  exhaustion. 

Treatment.  Relief  of  prominent  symptoms.  Ferruginous  tonics, 
with  good  nourishing  food,  are  useful  for  a  time. 

SUSPENDED  ANIMATION.— Synon.  Asphyxia;  Apnxa ;  Apnceas- 
phyxla. — May  result  from  syncope;  strangulation,  and  obstruction  of 
larynx  by  foreign  bodies;  inhalation  of  chloroform,  carbonic  acid,  or 
other  poisonous  gases;  nai'cotic  poison  ;  a  stroke  of  lightning ;  and 
drowning.  In  all  forms,  treatment  resolves  itself  into  allowing  free  in- 
gress of  pure  air  to  lungs;  and  then  inducing  warmth  and  circulation. 

Appearances  which  indicate  death :  Complete  cessation  of  breathing 
and  heart's  action;  eyelids  half  closed,  and  pupils  dilated;  jaws  clenched; 
tongue  appearing  between  teeth,  with  frothy  mucus  about  mouth  and 
nostrils;  lingers  semi-contracted;  with  increasing  coldness  and  pallor 
of  surface. 

1.  Drowning,  or  Suffocation. — The  following  rules  for  treatment  are 
essentially  those  drawn  up  by  Dr.  H.  R.  Silvester,  and  circulated  by  the 
Royal  Humane  Society: 

Rule  1. —  To  maintain  a  Free  Entrance  of  Air  into  the  Windpipe. — 
Cleanse  the  mouth  and  nostrils :  open  the  mouth :  draw  forward  pa- 
tient's tongue,  and  keep  it  forward  ;  an  elastic  band  over  the  tongue, 
and  under  the  chin  will  answer  this  purpose.  Remove  all  tight  cloth- 
ing from  about  neck  and  chest.  Make  sure  that  no  foreign  body  is 
lodged  in  pharjmx,  larynx,  or  oesophagus. 

Rule  2. —  To  adjust  the  Patient's  Position. — Place  the  patient  on  his 
back  on  a  flat  surface,  inclined  a  little  from  the  feet  upwards ;  raise  and 
support  the  head  and  shoulders  on  a  small  firm  cushion  or  folded  article 
of  dress  placed  under  the  shoulder-blades.  Supposing  that  natural  res- 
piration has  ceased,  proceed — 

Rule  3. —  To  imitate  the  Movements  of  Breathing. — GrasiD  patient's  arms 
just  above  the  elbows,  and  draw  the  arms  gently  and  steadily  upwards, 
until  they  meet  above  the  head  (this  is  for  the  purpose  of  drawing  air 
into  the  lungs)  ;  and  keep  the  arms  in  that  position  for  two  seconds. 
Then  turn  down  patient's  arms,  and  press  them  gently  and  firmly  for 
two  seconds  against  sides  of  chest  (this  is  with  the  object  of  pressing 
air  out  of  the  lungs.     Pressure  on  the  breast-bone  will  aid  this). 

Repeat  these  measures  alternately,  deliberately,  and  perseveringly, 
fifteen  times  in  a  minute,  until  a  spontaneous  effort  to  respire  is  per- 
ceived;  immediately  upon  which  cease  to  imitate  the  movements  of 
breathing,  and  proceed  to  iiiduce  circulation  and  warmth. 

Should  a  warm  bath  be  procurable,  the  body  may  be  placed  in  it  up 
to  the  neck,  continuing  to  imitate  movements  of  breathing.  Raise  the 
body  in  twenty  seconds  in  a  sitting  position,  and  dash  cold  water  against 


SYPHILIPHOBIA — SYPHILIS.  247 

chest  and  face,  and  pass  ammonia  under  nose.  Patient  should  not  be 
kept  in  warm  bath  longer  than  five  or  six  minutes. 

Rule  4. —  To  excite  Inspiration. — During  employment  of  above  method 
excite  nostrils  with  snuff  or  smelling-salts,  or  tickle  throat  with  a  fea- 
ther. Rub  chest  and  face  briskly ;  dash  cold  and  hot  water  alternately 
on  them. 

Rule  5. —  To  induce  Circulation  and  Warmth. — Wrap  patient  in  dry 
blaidvcts,  and  commence  rubbing  limbs  upwards,  firmly  and  energetically. 
Friction  must  be  continued  under  blankets  or  over  dry  clothing. 

Promote  warmth  of  body  by  a])plication  of  hot  flannels,  bottles  or 
bladders  of  hot  water,  heated  bricks,  &c.,  to  pit  of  stomach,  ai-mpits,  be- 
tween thighs,  and  to  soles  of  feet.  Warm  clothing  may  generally  be 
obtained  from  bystanders. 

On  restoration  of  life,  when  power  of  swallowing  has  returned,  a  tea- 
spoonful  of  warm  water,  small  quantities  of  wine,  warm  brandy  and 
water,  or  coffee,  should  be  given.  Patient  should  be  kept  in  bed  ;  dis- 
position to  sleep  encouraged.  During  reaction,  large  mustard  plasters 
to  chest  and  below  shoulders  will  greatly  relieve  distressed  breathing. 

2.  Intense  Cold. — Acts  chiefly  on  nervous  system.  There  is  giddi- 
ness; inability  to  see ;  weakness  and  rigidity  of  limbs  ;  almost  imper- 
ceptible respiration  and  pulse;  tendency  to  profound  sleep;  and  coma. 
— Attempt  restoration  of  circulation  and  sensibility  by  rubbing  body 
with  snow  or  ice  or  cold  water.  Friction  with  flannel  long-continued. 
Yery  gradual  application  of  warmth.  A  stimulating  enema, — unless 
warm  milk,  or  coffee,  or  beef  tea,  or  wine  can  be  swallowed. 

3.  Syncope. — From  Iu)'/.67ztu),  to  be  affected  with  sudden  prostration. 
Synon.  Swooning;  Fainting. — Remedies  for  fainting  are:  Recumbent 
position  with  head  low.  Cold  air.  Cold  water  dashed  over  head  and 
chest.  Friction  or  sinapisms  over  heart's  I'egion.  Small  quantities  of 
ammonia  or  brandy.  Galvanism  to  rouse  heart's  action. — In  apparently 
hopeless  cases  of  syncopic  from  hemorrhage,  a  full  dose  of  opium  in 
brandy.     Transfusion. 

4.  Intoxication,   or  Narcotic  Poisons. — Treatment  of:  Patient  to  be 

placed  on  his  side,  with  head  slightly  raised.  Cold  affusion.  Heat  to 
extremities.  Stimulating  embrocations  to  chest.  Use  of  stomach-pump, 
as  emetics  and  tickling  of  fauces  seldom  act  where  insensibility  is  great. 
Artificial  respiration.  Galvanism.  Strong  tea  or  coffee.  Solution  of 
acetate  of  ammonia. 

SYPHILIPHOBIA.— From  Syphilis;  and  <po§iu,,  to  dread.  Synon. 
Sijphiloinania ;  Noddle  Pox. — A  morbid  or  hypochondriacal  fear  of 
syphilis,  producing  imaginary  symptoms  of  the  disease. 

Symptoms.  Allied  to  those  presented  in  fictitious  cases  of  sperma- 
torrhoea or  impotence.  Great  mental  suffering.  Impairment  of  general 
health.     Urgent  desire  for  anti-syphilitic  drugs. 

Treatment.  Some  preparation  of  zinc  with  strychnia  or  nux  vomica, 
407,  411.  Iron,  380,  387,  408.  Mineral  acids,  376.  Ilypophosphite  of 
soda  and  bark,  419.  Cod-liver  oil  Good  diet.  Cold  or  tepid  baths. 
Sea  air. 

SYPHILIS. — Several  derivations  have  been  given  of  this  word;  but 
according  to  Dr.  Mayne  none  seem  better  than  that  of  Blancardus, — 
2'yK,  together;  <pdi<u,  to  love.  Synon.  Lues  Venerea;  Venereal  Disease; 
Fox. 


248  SYPHILIS. 

1.  Primary  Syphilis. — Occurs  as  a  specific  ulcer  or  chancre,  the  nicer 
ap|)earinu;  on  the  part  to  which  the  virus  has  been  directly  applied. 
There  are  four  distinct  varieties  of  sores: 

(1)  Indurated,  Hunterian,  Infecting,  or  True  Chancre. — It  is 
accompanied  by  the  adhesive  inflammation,  and  gives  rise  to  a  specific 
chronic  enlargement  of  the  inguinal  glands.  It  is  followed  by  consti- 
tutional s^'mptoms.  A  period  of  incubation,  varying  from  ten  days  to 
six  or  seven  weeks,  elapses  from  the  time  of  inoculation  to  the  appear- 
ance of  the  induration.  The  sores  are  characterized  by  their  margins 
and  bases  being  indurated  from  the  effusion  of  lymph;  while  the  secre- 
tion from  them  is  scanty,  and  formed  of  serum,  Ij-mph  globules,  and 
epithelial  debris.  This  secretion  is  not  inoculable  upon  the  infected 
party.  A  mercurial  course,  similar  to  that  required  in  constitutional 
sypliilis,  is  necessary. — See  Syphilization. 

(2)  SiMPLK,  Soft,  Non-indurated  Chancre. — Accompanied  by  sup- 
purative inflammation.  It  is  a  local  disease,  not  followed  by  secondary 
symptoms.  There  are  one  or  more  sores,  with  Avell-defined  edges, 
looking  as  if  portions  of  healthy  tissue  had  been  punched  out.  The 
secretion  abundant  and  purulent;  auto-inoculable.  If  seen  within  five 
days  from  inoculation,  effective  cauterization  will  destroy  the  sore  and 
virus.  Best  caustics, — nitric  acid,  acid  solution  of  nitrate  of  mercury, 
potassa  fusa.  In  other  cases  astringent  lotions.  Ferruginous  tonics. 
Nourishing  food. 

(3)  Phagedenic  Chancre. — Accompanied  by  ulcerative  inflamma- 
tion. The  ulcer  is  small,  irritable,  ragged,  secreting  unhealthy  pus. 
The  sore  has  a  tendency  to  spread  irregularly.  A  suppurating  bubo 
forms,  Avhich  yields  inoculable  pus.  It  is  not  followed  by  constitutional 
S3'philis,  and  does  not  usually  require  specific  remedies.  Fomentations 
and  ]30ultices,  or  soothing  lotions.  Bark  and  nitric  acid.  Ferruginous 
tonics.  Iodide  of  potassium  and  sarsaparilla.  Nourishing  diet,  fi'ee 
from  stimulants. 

(4)  Sloughing  Chancre,  or  Gangrenous  Phagedena. — Accompa- 
nied by  mortification.  It  does  not  aflTect  the  inguinal  glands,  is  not 
followed  by  constitutional  infection,  and  requires  only  local  treatment. 
Sometimes  the  disease  so  severe,  that  the  prepuce  and  a  portion  of  the 
glaiis  may  be  destroyed.  In  enfeebled  prostitutes  the  Avhole  of  the 
labia  and  nj^mphfe  may  slough  away.  Fomentations  and  poultices. 
Opium.     Nourishing  food.     Stimulants.     Confinement  to  bed. 

2.  Constitutional  Syphilis. — Result  of  indurated  or  infecting  chancre. 
Many  cases  of  chronic  ill-health  are  due  to  it;  while  it  is  often  the 
cause  of  obscure  diseases  of  the  vital  organs,  affections  of  the  bones, 
reltel lions  ulcers  of  the  cutaneous  or  mucous  surfaces,  troublesome  skin 
diseases,  impotence  or  sterility,  abortion,  and  the  death  of  the  foetus  in 
utero. 

Symptoms.  In  the  beginning  there  is  general  disturbance  of  the 
sj'stem.  Then  fever,  mental  dejjression,  lassitude,  pains  in  the  limbs, 
and  a  sallow  hue  of  skin.  Shortly,  unmistakable  evidence  afforded  by 
the  ])roduction  of  certain  copper-colored  cutaneous  diseases;  ulcers  on 
the  skin;  warts,  and  condylomata  or  mucous  tubercles;  tumors  of  the 
skin  and  subcutaneous  areolar  tissue;  alopecia  or  baldness,  and  loss  of 
the  eyebrows  and  eyelashes;  syphilitic  iritis;  discoloration  and  crumb- 
ling of  nails,  or  inflammation  and  ulceration  about  their  roots;  superfi- 
cial ulcerations  on  the  tongue,  lips,  and  pillars  of  the  fauces;  ulceration 
of  the  larynx  ;  diseases  of  the  periosteum  and  bones  ;  pain  about  middle 
of  sternum ;  and  in  a  few  instances,  and  as  late  tertiary  symptoms, 
by  sei'piginous  ulceration  of  the  skin,  as  well  as  by  diseases  of  the 
brain,  spinal  cord,  lungs,  heart,  liver,  &c. 


SYPHILIZATION.  249 

Treatment.  Diet  liglit  and  nutritious;  fish,  moat,  milk,  cream,  i*aw 
Cfijgs ;  claret  or  sherry  and  water.  Warm  clothing,  flannel,  and  avoid- 
ance of  cold  and  damp.  Warm  water  or  vapor  baths.  Blue  pill. 
Calomel.  Compound  calomel  pill.  Mercury  and  chalk.  Inunction 
with  mercurial  ointment ;  sixty  or  more  grains  every  night.  Mercurial 
vapor  baths,  131.  Solution  of  corrosive  sublimate,  given  for  many 
weeks,  27.  Green  iodide  of  mercury,  58.  Eed  iodide  of  mercur}-, 
54.  Donovan's  solution,  51.  Iodide  of  potassium,  31.  Iodide  of 
sodium,  39.  Iodide  of  iron,  32.  Opium.  Cod-liver  oil. — "-Derivative" 
treatment  as  practised  by  Dr.  Ujort :  Application  to  different  parts  of  body, 
beginning  between  the  scapuhe,  of  stibiatc  plasters  (made  with  one 
part  of  powdered  tartarated  antimony  and  three  of  adhesive  plaster, 
melted  together),  the  size  of  a  visiting  card.  As  soon  as  good  pustules 
are  produced,  poultices.  At  same  time,  caustics  to  mucous  tubercles, 
ulcers  on  fauces,  &c. — The  ^^ Zittmann"  eliminative  plan  consists  of  rest 
in  bed  in  a  warm  room:  a  very  moderate  diet  without  stimulants: 
a  purgative  every  second  day  :  and  the  production  of  sweating  by 
copious  draughts  of  compound  decoction  of  sarsaparilla.  Subsequently 
a  course  of  tonics  or  of  alkaline  waters. — See  Syphilization. 

3.  Infantile  Syphilis. — May  be  hereditary  or  acquired.  Infant  usually 
born  healthj'-looking :  but  sometimes  with  its  skin  of  a  dull  color,  and 
its  features  contracted — like  a  little  old  man. 

Symptoms.  Generally,  within  the  month,  symptoms  of  coryza  set  in  j 
cough,  difficulty  in  sucking,  dryness  of  the  lips  and  mouth,  the 
"snuffles."  Voice  shrill  and  coarse.  Superficial  ulcerations  about 
mouth  and  throat.  Parts  around  the  mouth,  nosti'ils,  buttocks,  arms, 
and  flexures  of  joints  become  copper-colored,  fissured,  and  excoriated. 
Child  wastes  and  gets  very  weak.  Amyloid  disease  of  liver.  Indui-ated 
nodules  in  lungs.  Syphilitic  iritis.  Chronic  interstitial  keratitis.  Deaf- 
ness.— In  children  with  inherited  syphilis:  A  peculiar  physiognomy. 
Tendency  to  chi'onic  interstitial  keratitis.  Notching  of  central  upper 
incisors  of  permanent  teeth  (Hutchinson). 

Treat.ment.  Mercurial  inunction.  Mercury  and  chalk.  Iodide  of 
potassium.  Chlorate  of  potash.  A  healthy  wet-nurse?  Feeding  by 
hand, — goats',  asses',  or  cows'  milk — See  Syphilization. 

SYPHILIZATION. — A  term  applied  by  Auzias  Turenne  to  the  condi- 
tion produced  by  successive  inoculations  with  syphilitic  poison  ;  in 
which  each  succeeding  chancre  becomes  less  and  less,  until  a  time 
arrives  when  no  ulcer  can  be  produced  by  insertion  of  venereal  virus. 
Hence  the  inference  has  been  drawn  that,  by  prolonged  inoculation,  a 
constitutional  state  is  induced  in  which  the  system  is  no  longer  capable 
of  being  affected  b}'  syphilis. 

To  obtain  pei'fect  syphilization  or  immunity,  an  individual  must  un- 
dergo constitutional  syphilis:  he  must  be  forced  rapidly  through  this  state 
by  repeated  inoculations,  so  that  his  organization  may  not  be  injured. 
Sperino  inoculates  for  from  six  to  ton  chancres  at  each  sitting;  and  allows 
three  or  four  days  to  elapse  between  each  operation.  By  continued 
inoculation  the  ulcers  become  less  and  less  until  no  effect  is  produced  ; 
but  the  individual  is  still  susceptible,  though  in  a  less  degree,  to  another 
kind  of  matter,  again  to  a  third,  and  so  on  until  at  last  no  effect  is  pro- 
duced by  any  syphilitic  poison.  The  general  health  instead  of  suffering, 
improves  during  process  of  inoculation.  Time  required  to  produce 
immunity  varies:  in  one  case  it  was  obtained  after  71  chancres;  in 
most  instances  upwards  of  3j0  were  produced,  treatment  lasting  for 
nine  or  twelve  or  twenty  months  and  more.     It  may  be  practised  at 


260  TABES    DORS'ALIS TEMPERATURE    OF    BODY. 

any  age.  To  obtain  a  complete  cure  when  patient  has  previously 
been  mercurialized,  the  use  of  iodine  has  often  to  be  combined  with 
syphilization.  Dr.  Boeck  asserted  in  1858,  in  consequence  of  results 
he  had  obtained  from  83'philization  alone  in  those  who  had  not  been 
previously  mercurialized,  that  in  no  disease  has  the  ■practitioner  a  more 
certain  method  of  cure.  Disadvantages  of  the  method, — its  offensive 
nature,  and  the  length  of  time  necessary  for  effectually  carrying  it  out  j 
on  the  other  hand,  the  immunity  produced  is  thought  to  last  for  life. 

TABES  DOESALIS. — From  Tabeo,  to  waste  away;  dorsum,  the  back. 
Synon.  PlUhisis  Uorsalis ;  Myelophthisis. — A  state  of  atrophy  of  poste- 
rior columns  of  spinal  cord  producing  palsy. — See  Paralysis. 

TABES  MESENTERIC  A.— From  Tabeo,  to  melt  away;  Meav.ripw^,  the 
membrane  which  connects  the  intestines  together, — p.iffo':,  'ivztpov.  Synon. 
Phthisis  Mesaraica ;  Scrofula  Mesenterica;  Mesenteric  Disease;  Abdominal 
Phthisis. — A  tubercular  degeneration  of  the  mesenteric  glands.  Tuber- 
cle effused  into  the  glands,  destroying  their  structure,  and  obstructing 
the  passage  of  chyle  through  the  convoluted  lacteals  traversing  them. 
Particularly  affects  infants  and  young  children.  Often  combined  with 
tubercular  peritonitis. 

Symptoms.  More  or  less  constant  pain  in  bowels  :  sometimes  severe, 
causing  legs  to  be  drawn  up  towards  belly.  Deep  red  color  of  lips : 
angles  of  mouth  covered  with  small  ulcers,  or  lips  fissured.  Irregular 
action  of  bowels:  motions  generally  frequent,  watery,  unhealthy,  and 
fetid.  Abdomen  swollen  and  tense  :  wasting  of  other  parts  of  body 
until  extreme  emaciation  ensues.  Great  pallor :  general  debility,  weak- 
ness rapidly  increasing.  Recovery  occasionally  takes  place,  if  disease 
be  checked  before  functions  of  glands  are  much  impeded.  Symptoms 
of  pulmonar}'  consumption,  or  of  tuberculization  of  bronchial  glands, 
or  of  tubercular  meningitis  may  supervene. 

Treatment.  Phosphate  of  iron  ("  Chemical  Food"),  405.  Hypo- 
phosphite  of  soda  or  lime,  419.  Ammonia  and  bark.  Cod-liver  oil,  389. 
Steel  wine.  Tincture  of  perchloride  of  iron.  Ammonio-citrate  of  iron. 
Iodide  of  iron.  Quinine.  Iodide  of  ammonium.  Iodide  of  potassium. 
Solution  of  chlorinated  soda.  Peroxide  of  hydrogen  in  weak  solution. 
Glycerine.  Taraxacum,  bicarbonate  of  potash,  and  sarsaparilla.  Mer- 
cury and  chalk,  with  soda  and  magnesia,  34.  Mercury  and  chalk,  with 
powder  of  ipecacuan  and  opium.  Aromatic  powder  of  chalk  and  opium. 
Bismuth.  Logwood.  Catechu  and  chalk  mixture. — Mild  nourishing 
food.  Asses'  or  goats'  milk.  Milk  and  soda  water.  Milk  and  lime- 
water.  Cream.  Paw  eggs.  Carrageen  or  Irish  moss.  Eaw  minced 
beef,  2. — Friction  of  abdomen  with  soap  or  opiate  liniments.  Linseed 
poultices.  Wet  compress.  Warm,  or  tepid,  salt  water  baths.  Iron,  or 
oak  bark,  baths,  126.  Warm  clothing.  Flannel  bandage  round  abdo- 
men, night  and  da3^  Well-ventilated  sleeping-room.  Sea  air, — Mar- 
gate, Broadstairs,  Folkestone,  431;  Scarborough,  439;  Brighton,  Hast- 
ings, 432 ;  Ventnor,  434. 

TEMPERATURE  OF  BODY.— The  normal  temperature  at  unexposed 
parts  of  surface  is  98.4°  Fahr.  A  persistent  rise  above  99.5°,  and  a  con- 
tinued depression  below  97.3°,  are  indicative  of  disease.  The  increase 
above  99°  is  the  best  index  of  amount  of  fever  present. 

Observations  should  be  taken  at  least  every  morning  and  evening, 
alwaj'S  at  the  same  hour,  throughout  the  whole  illness.  Pulse  and  res- 
pirations to  be  noted  at  same  time.  The  bulb  of  thermometer  to  be  ap- 
plied to  armpit,  groin,  or  belly :  to  be  kej^t  in  close  contact  with  skin : 


TESTICULAR    NEURALGIA TEPTITIS.  251 

to  remain  in  situ  for  at  least  three  minutes.  Were  it  not  for  obvious 
objections,  the  rectum  would  be  the  best  situation.  A  very  sensitive 
curved  thermometer,  and  a  straight  self-registering  instrument,  can  be 
obtained  in  a  convenient  case  from  Mr.  L.  Casella,  23  Hatton  Garden, 
London. 

There  is  a  continuous  elevation  of  temperature  in  all  cases  of  pro- 
gressive tubercxdosis  from  the  beginning;  the  temperature  becoming 
normal  when  the  disease  becomes  arrested. — A  continued  elevation 
occurs  in  all  acute  inflammatory  diseases.  In  rheumatism :  empyema  :  sup- 
puration :  continued  and  eruptive  fevers,  &c.  During  paroxysms  of  ague, 
from  commencement  of  the  rigor  to  the  termination  of  the  sweating 
stage. — A  persistent  temperature  of  105°  is  indicative  of  danger,  or  of 
a  tendency  to  some  important  complication,  m  pneumonia,  typhoid  fever, 
typhus,  small-pox,  measles,  scarlet  fever,  erysipelas,  acute  rheumatism,  and 
ichorhcemia.  In  any  case,  a  rise  above  106°  very  unfiavorable :  above 
110°,  disease  in  all  probability  will  be  fatal.  In  typhoid  fever,  a  sudden 
fall  below  normal  heat  has  indicated  the  occurrence  of  hemorrhage  from 
ulcerated  Peyer's  patches,  manj''  hours  before  blood  has  appeared  in  the 
stools. — During  convalescence  from  acute  disease,  a  sudden  rise  in  temper- 
ature may  be  the  first  indication  of  a  relapse  :  an  abnormal  fall  (as  to 
95°)  shows  a  tendency  to  collapse  and  indicates  the  need  of  hot  appli- 
cations, stimulants,  warm  soups,  &c. 

TESTICULAR  NEURALGIA.— There  may  be  merely  increased  sen- 
sibility of  the  testicle, — irritable  testis.  Or  the  pain  will  be  most  distress- 
ing, assuming  the  character  of  true  neuralgia.  No  swelling  or  increase 
of  heat:  but  only  intolerance  of  least  pressure,  and  retraction  of  gland 
close  to  the  groin  during  the  paroxysms.  Either  irritable  testicle  or 
neuralgia  may  arise  from  onanism,  or  excessive  intercourse;  disease  at 
prostatic  part  of  urethra;  as  a  sequel  of  testitis;  from  gout;  dyspepsia, 
with  very  acid  urine;  a  calculus  in  kidney  or  ureter;  varicocele,  &c. 
The  remedies  are:  Belladonna,  aconite,  and  opium  locally  applied:  cold 
lotions,  or  even  ice  bag:  subcutaneous  injections  of  morphia  into  scrotum. 
Quinine;  iron;  arsenic;  valerianate  of  ammonia  or  zinc.  When  pain 
has  been  very  acute,  patients  have  demanded  castration  :  compliance 
with  such  a  wish,  perfectl}'  unjustifiable,  save  in  very  exceptional  in- 
stances. Were  castration  resorted  to,  the  pain  would  return  in  the  cord, 
unless  due  to  actual  disease  of  the  gland. 

TESTICULAR  TUMORS.— The  testicle  may  be  the  seat  of  a  fibrous 
transformation.  Of  fibro-plastic  or  myeloid  growths;  or  of  enchondro- 
matous  (cartilaginous)  tumors.  Non-malignant  c^'Sts  of  different  kinds 
may  form,  by  dilatation  of  the  seminiferous  tubules  {hydatid  disease  of 
Sir  Astley  Cooper;  cystic  sarcoma  of  recent  writers).  Very  rarely,  ma- 
lignant cystic  disease  has  occurred.  Scirrhous  is  less  frequent  than  me- 
dullary cancer.  Young  children  are  occasionally  affected  with  scirrhus, 
more  often  with  encephaloid.  Extirpation  is  the  only  remedy  in  all 
cases,  where  treatment  is  really  necessary.  In  cystic  sarcoma,  a  per- 
fect cure  may  be  hoped  for  by  removal :  in  cases  of  carcinoma  a  recur- 
rence is  very  much  to  be  feared. 

TESTITIS. — From  Testis,  a  witness, — because  the  testicle  is  a  proof 
of  virility  ;  terminal  -itis. — Inflammation  of  the  testicle  may  be  acute  or 
chronic ;  or  it  may  be  specific, — syphilitic,  or  tubercular. 

1.  Acute  Testitis. — Synon.  Hernia  Humoralis ;  Orchitis;  Orchiocele; 
Swelled  Testicle. — Generally  due  to  extension  of  gonorrhoeal  inflamraa- 


252  TESTITIS. 

ttion  from  urethra;  such  inflammation  havinj>;  been  often  aggravated  by 
•strong  injections,  use  of  alcoholic  drinks,  active  exercise,  neglecting  to 
•M'ear  a  suspensory  bandage,  &c.  The  central  portion  or  body  of  the 
gland  may  be  affected;  or  the  epididymis  and  tunica  vaginalis  may  be 
attacked  (epididymitis);  or  all  these  parts  may  suffer. 

Symptoms.  Pain  and  feeling  of  weight  in  cord  and  testicle.  Uneasi- 
'jiess  about  the  loin,  groin,  and  upper  part  of  thigh.  Frequent  micturi- 
tion. Diminution  of  urethral  discharge.  Swelling  of  testicle,  from  eifn- 
sion  of  serum  and  lymph  into  tunica  vaginalis  :  scrotum  firm  and  tense: 
.swelling  of  cord.  Great  tenderness;  pressure  aggravates  thcjniin.  Feb- 
xi\e  disturbance:  nausea  and  vomiting:  constipation.  Abscess  rarely 
forms.     Very  seldom  the  inflammation  has  ended  in  gangrene. 

Treatment.  Prior  to  setting  in  of  swelling  the  disease  may  perhaps 
be  checked  by  antimonial  emetics,  231.  Alkaline  aperients, — Sulphate 
of  soda  and  taraxacum,  144.  Sulphate  and  carbonate  of  magnesia  with 
colchicum,  141.  Iodide  of  potassium,  31.  Aconite,  330,  331.  Opium,  in 
doses  sufficient  to  relieve  pain.  Eest  in  bed :  scrotum  to  be  supported 
by  small  pillows.  Hot  fomentations,  with  ap])lication  of  extracts  of  bel- 
ladonna and  poppies,  297.  Pressure  by  means  of  strajiping,  or  of  strips 
of  mercurial  plaster,  methodically  applied:  seldom  to  be  used  till  to- 
wards the  end  of  acute  stage. 

Puncture  with  a  thin  sharp  knife  into  body  of  testis,  so  that  by  di- 
vision of  tunica  albuginea  the  pressure  on  lobules  and  convoluted  tubes 
may  be  removed:  the  incision  allows  a  quantit}^  of  serum  and  a  few 
drachms  of  blood  to  escape:  there  is  immediate  i-elief,  the  process  sel- 
dom requiring  repetition  (Henry  Smith).  Puncture  of  the  testicle,  fol- 
lowed as  soon  as  bleeding  has  ceased  by  tight  comiircssion  with  strap- 
ping: administration  of  one  grain  of  opium  (Spencer  Watson). 

2.  Chronic  Testitis. — Synon.  Sarcocele,  from  -r/^'l,  flesh;  xrjh,  a  swell- 
ing.— Is  either  the  sequel  of  an  acute  attack;  or  the  inflammation  may 
be  subacute  or  chronic  from  commencement.  May  be  due  to  stricture 
of  urethra;  to  gleet;  or  to  a  sj-phiiitic  taint. 

Symptoms.  Morbid  action  usually  begins  in  cpidid3-mis,  and  extends 
to  bod}'  of  testicle.  There  is  swelling,  hardness,  and  tenderness  on  pres- 
sure :  a  sense  of  weight.  Sometimes,  cfl'usion  of  serum  into  tunica  vagi- 
nalis— hydro-sarcocele.  When  due  to  constitutional  syphilis  (syphilitic 
sarcocele)  there  are  other  manifestations  of  this  state:  pustular  or  scaly 
skin  eruptions,  rheumatic  pains  with  nocturnal  exacerbations,  ulcers 
about  tongue  or  throat,  derangement  of  general  health,  and  sometimes 
iritis. 

Treatment.  Removal  of  cause  :  examination  of  urethra  for  stricture, 
&c.  Avoidance  of  active  exercise.  Use  of  suspensoi-y  bandage.  Pres- 
sure, firmly  and  evenly  applied,  by  encircling  the  gland  with  strips  of 
strapping  or  of  mercurial  plaster.  Iodine  liniment  diluted.  Red  iodide 
of  mercury  ointment  diluted,  3(12.  Iodide  of  potassium,  31.  Mercurial 
vapor  baths,  131.  Red  iodide  of  mercury,  54.  Corrosive  sublimate  with 
sarsaparilla,  27. 

3.  Abscess  and  Fungus  of  Testicle. — May  result  from  acute  or  chronic 
inflammation.  When  fluctuation  can  be  detected,  and  the  skin  is  ad- 
herent, a  puncture  should  be  made;  pressure  being  ap])lied  after  evacu- 
ation of  the  pus. 

Sometimes,  when  matter  forms,  the  tunica  albuginea  gets  perforated; 
the  integument  thins  and  gives  way;  and  through  the  opening  a  j)ro- 
trusion  of  flbro-plastic  matter  with  some  of  the  tubular  structure  takes 
place.  There  is  but  little  pain.  The  fungus  slowly  increases;  unless  it 
has  been  returned  and  kept  in  place  by  strapping,  after  separating  by 


TETANUS.  253.' 

dissection  the  thickened  inte<^ument  adherent  to  the  maririns  of  the 
woiinil,  and  tlien  carefiUly  britii^ini!;  tiie  edges  togetlier.  Where  the  pro- 
truded part  has  become  disorganized,  it  must  be  sliced  otf, — a  jiroceed- 
ing  equivalent  to  partial  castration. 

4.  Scrofulous  Testicle. — Slow  and  anbacute  inflammation,  with  deposit 
of  tubercular  matter  between  the  tubuli  seminiferi,  or  into  the  epididy- 
mis. 

Symptoms.  Formation  gradually  of  a  nodular  swelling,  without  pain. 
Tumor  seldom  attains  much  size.  Softening  and  suppuration  ;  the  swell- 
ing bursts,  pus  and  tubercular  matter  coming  away;  sinuses  form,  and 
communicate  with  similar  enlargements.  The  sores  may  put  on  a  healthy 
character,  or  there  may  be  a  protrusion  of  tubular  structure, — fungus  of* 
testicle.     Tubercular  (lisease  of  lungs  often  also  jiresent. 

TaEATME.NT.  Nourishing  food  :  .stimulants,  milk,  cream,  raw  eggs, 
beef  solution,  2.  Sea  air.  Cod-liver  oil.  Ammonia  and  bark.  TIj'po- 
phosphites  of  soda  or  lime,  anil  bark,  419.  After  evacuation  of  pus, 
pressure  by  strapping.  Lotions  of  sulphate  of  zinc,  264;  or  iodine,  260. 
Where  constitutional  disturbance  is  great,  removal  of  source  of  irritation' 
b^''  castration  may  be  required. 

TETANUS. — From  'AcVw,  to  bend  or  strain.  Synon.  Rigor  Nervorum; 
Spasm  with  Rigidity. — A  disease,  the  chief  feature  of  which  is  long-con- 
tinued contraction  or  spasm  of  a  certain  number  of  the  voluntary  mus- 
cles. Rigidity  of  muscles  continuous,  and  hence  spoken  of  as  tonic 
spasm  or  i<pastic  contraction  ;  in  contradistinction  to  clonic  spasms  of  con- 
vulsions, where  there  are  alternate  contractions  and  relaxations. — '■ 
Cases  oi"  idiopathic,  move  hopeful  than  of  ^yaumn^ic,  tetanus.  Symptoms 
very  similar  to  those  produced  by  poisonous  dose  of  strychnia. 

Symptoms.  Usually  siU  in  suddenly  :  muscles  of  jaws  and  throat  first 
affected.  Patient  complains  that  he  has  taken  cold,  and  as  if  he  had 
got  a  sore  throat  and  stiff  neck;  but  stiffness  and  uneasiness  soon  in- 
crease, and  extend  to  the  root  of  the  tongue  causing  difficulty  in  swal- 
lowing. Temporal  and  masseter  muscles  gradually  get  involved  ;  lock- 
jaw or  trismus  {T/j{'^(o,  to  gna^h  with  the  teeth)  occurs.  VYlien  disease 
proceeds,  remaining  muscles  of  face,  trunk  and  extremities  become  im- 
plicated. Spasms  never  entirely  cease,  except  in  son\o  cases  during 
sleep:  aggravated  every  quarter  of  an  hour  or  so,  increased  cramp  last- 
ing for  a  few  minutes  and  then  partially  subsiding. — Where  strong 
muscle-)  of  back  are  most  affected,  they  bend  body  into  shape  of  an 
arch,  so  that  ]iaticnt  rests  upon  head  and  heels,  a  condition  known  as 
opisthotonos  ('0-c/tO:,  backwai-ds;  r ztxu,  to  band). — When  body  is  bent 
forwards  by  strong  contraction  of  the  mviscles  of  neck  and  abdomen, 
affection  termed  emprosthotonos  (^Efj-potrOzv,  forwards,  and  T-i>iij). — If 
muscles  are  affected  laterally,  so  tl.at  body  is  curved  sideways,  the  dis- 
ease has  been  designated  pleurosthotonos  {^llhupoOtv,  from  the  side,  and 
Tct'vw),  or  tetanus  lateralis 

Frightful  suffering  caused  by  tetanic  spasms.  Face  pale;  brows  con- 
tracted; skin  covering  forehead  corrugated;  eyes  fi.xed  and  prominent 
— sometimes  suffused  with  tears;  nostrils  dilated;  corners  of  mouth 
drawn  back,  teeth  exposed,  and  features  fixed  in  a  grin — risus  sardon- 
icus.  Respirations  performed  with  difficulty  and  anguish;  severe  pain 
at  sternum;  great  thirst,  but  agony  increased  by  attempts  at  deglu- 
tition; pulse  feeble  and  frequent;  skin  covered  with  pei-spiration  ;  pa- 
tient cannot  sleep,  or  if  he  dozes  it  is  only  for  a  few  minutes  ai  a  time. 
With  all  this  suffering,  iiUellect  remains  clear  and  unaffected.  Death 
usually  occurs  between  third  and  fifth  days;  partly  from  suffocation, 
partly  from  exhaustion. 


264  THROMBOSIS — TINEA. 

Treatment.  Empirical  and  often  useless.  Full  doses  of  calomel  and 
jalap,  until  bowels  are  freely  acted  on.  Inhalation  of  chloroform,  more 
or  less  insensibility  being  kept  up  for  many  hours.  Belladonna  locally, 
and  internally.  Quinine  in  full  doses,  with  or  without  belladonna.  Sub- 
cutaneous injections  of  liquor  atropiae,  314.  Subcutaneous  injections  of 
solution  of  active  principle  of  woorara — the  alkaloid  curarina.  Nicotine 
(one  or  two  drops  for  a  dose).  Powder  of  Old  Calabar  bean  (one  grain 
to  six  for  a  dose).  Aconite.  Conium.  Sulphite  of  soda  or  magnesia, 
if  disease  be  thought  due  to  absorption  of  morbid  matters,  48.  Pro- 
longed application  of  ice  to  spine. 

Opium  objectionable:  produces  a  state  of  congestion  and  polar  excite- 
ment of  spinal  cord.  Bloodletting;  blisters;  cold,  hot,  and  vapor 
baths;  mercui-y  ;  antimony;  colchicum  ;  large  doses  of  assafcetida;  tur- 
pentine; digitalis;  glonoin  ;  musk;  iron;  hydrocyanic  acid;  Indian 
hemp, — all  have  been  fruitlessly  employed. — See  Trismus  Nascentium. 

THROMBOSIS. — By  this  term  (from  BposiSo':,  a  clot  of  blood)  is  gen- 
erally understood  the  partial  or  complete  closure  of  a  vessel,  by  a  mor- 
bid product  developed  at  the  site  of  the  obstruction.  The  coagulum, 
which  is  usually  fibrinous,  is  known  as  autochthonous  clot  or  throvibus. 

Thrombi  mostly  met  with  in  diseases  attended  with  exhaustion. 
Particularly  in  croup,  diphtheria,  scarlatina,  endocarditis,  pneumonia, 
phthisis,  typhus,  purpura,  erysipelas,  hemorrhage,  &c.  Their  formation 
favored  by  condition  of  blood  during  pregnancy  and  puerperal  state. 

Treatment.  Variable  according  to  the  symptoms.  Indications  gen- 
erally are  to  support  the  vital  powers  and  allay  irritability.  Brandy. 
Eum.  Essence  of  beef,  2,  3.  Milk.  Brandy  and  eggs,  17.  Ammonia, 
361,  371.  Ether,  367.  Quinine,  379.  Bark.  Opium,  316,  318,  340. 
Sulphite  of  magnesia,  48.     Pure  air.     Perfect  rest. 

THRUSH. — A  disease  of  the  mouth  occurring  in  infants.  Synon, 
Aphtha  lufantmn ;  Fehris  Aphthosa ;  Vesicular  Gingivaruvi;  Milk  Thrush. 
— See  Aphtha;  of  Mouth. 

TIC  DOULOUREUX. — Severe  attacks  of  neuralgic  pain  in  nerves  of 
face.  Infra-orbital  branches  of  fifth  pair,  most  frequent  seat.  Synon. 
Neuralgia  Faciei ;  Painful  Tic. — See  Neuralgia. 

TINEA. — From  Tinea,  any  gnawing  or  destructive  worm. — Applied 
generally  to  those  cutaneous  diseases  which  are  due  to  presence  of  epi- 
phytes or  parasitic  plants.     All  are  contagious.     Five  varieties : 

1.  Tinea  Tonsurans. — From  Tonde.o,  to  shave, — because  of  the  brittle- 
ness  of  the  affected  hairs.  Synon.  Porrigo  Scutulata;  Scalled  Head; 
Herpes  Tonsurans;  Herpes  Circinatus ;  Trichosis  Furfuracea ;  Bingworm. 
A  chronic  contagious  disease,  known  by  decolorization  and  brittleness 
of  affected  hairs,  scaly  eruption,  and  roundness  of  diseased  patches. 
Most  common  on  the  scalp.  The  parasite  is  the  Tricophyton  Tonsurans; 
the  sporules  and  mycelium  of  which  intiltrate  the  texture  of  each  hair, 
while  they  also  spread  among  the  epithelial  scales. 

Treatment.     See  Tinea  Sycosis. 

2.  Tinea  Favosa. — From  J^a ?;?/.«,  a  honeycomb.  Synon.  Favus ;  Tinea 
Lupinosa ;  Porrigo  Favosa;  Honeycomb  Jlingworm. — Very  rare.  Most 
commonly  affects  the  scalp,  in  form  of  small  cup-shaped,  dry,  yellow 
crusts;  each  crust  containing  a  hair  in  its  centre,and  resembling  a  piece 
of  honeycomb.  Attended  with  severe  itching;  hairs  become  brittle 
and  fall  out;  crusts  have  a  mouldy  offensive  odor  and  are  often  sur- 


TONGUE    DISEASES.  255 

rounded  with  lice.     The  cryptogamic  parasitic  cause  is  the  Achorion 
Schonleinii. 
Treatment.     See  Tinea  Sycosis. 

3.  Tinea  Decalvans. — From  Becalvo,  to  make  bald.  Sjnon.  Porrigo 
Decalvans;  Alopecia  Circumscripta ;  Alopecia  Areata. — The  hair  falls  off 
one  or  more  circular  or  oval  spots;  leaving  perfectly  smooth  bald 
patches.     The  parasitic  fungus  is  the  Microsporon  Audouini. 

Treatment.     See  Tinea  Sycosis. 

4.  Tinea  Sycosis. — From  luxo/mi,  to  become  like  a  fig.  Synon.  Roseola 
Ficosa ;  Sycosis;  Mentagra  ;  Ghinwhelk;  Barber's  Itch. — Characterized  by 
inflammation  of  the  hair  follicles;  causing  successive  eruptions  of  small 
acuminated  pustules,  which  have  been  said  to  have  a  granulated  ap- 
pearance resemblance  the  substance  of  a  fig.  Occurs  most  frequently 
on  chin,  and  other  parts  co^^ered  by  the  beard.  The  parasite  is  the 
Mici'osporon  Mentagrophytes. 

Treatment.  Attention  to,  cleanliness.  Eemoval  of  hairs  with  scis- 
sors, or  extraction  by  forceps — epilation.  Separation  of  all  scabs  or 
incrustations  by  poultices  and  simple  ointments  or  oil.  Improvement 
of  general  health  by  generous  diet;  cod-liver  oil;  bark,  quinine,  steel. 
Destruction  of  parasitic  plant  by  sulphurous  acid  lotion,  27:^;  creasote 
or  carbolic  acid,  270;  corrosive  sublimate,  271;  a  mixture  of  equal  parts 
of  calomel,  creasote,  and  sulphur  ointment;  diluted  citrine  ointment, 
305;  ammoniated  mercury  and  sulphur  ointment,  300;  or  iodide  of  sul- 
phur ointment,  310.  In  ringworm  especially,  painting  with  strong  acetic 
acid ;  or  glacial  acetic  acid,  washing  the  part  directly  afterwards.  In 
tinea  decalvans,  frequent  painting  with  liniment  of  cantharides. 

5.  Tinea  Versicolor. — From  Versicolor  {verso  and  color),  that  changes 
its  color.  Synon.  Chloasma;  Pityriasis  Versicolor;  Macula  Hepatica ; 
Liver  Spot. — Makes  its  appearance  generally  on  front  of  chest  or  abdo- 
men, in  form  of  yellowish  patches  covered  with  small  branny  scales. 
Caused  by  a  cryptogamic  plant, — the  Microsporon  Furfur. 

Treatment.  Sulphurous  acid  lotion,  272.  Corrosive  sublimate  lini- 
ment, 271.  Thorough  cleanliness.  Flannel  vests  to  be  soaked  in  boil- 
ing water.     In  obstinate  cases, — arsenic,  52. 

TONGUE  DISEASES.— The  tongue  is  exposed  to  many  sources  of  dis- 
ease and  injur3\  A  highly  sensitive  organ  :  hence,  slight  diseases  of  its 
mucous  membrane,  or  of  its  muscular  fibres,  are  commonly  very  painful. 

1.  Glossitis. — From  nai<T(Ta,  the  tongue;  terminal -«Y;'.s.  Synon.  Angina 
Lingiudis;  Inflammatio  Linguce. — Inflammation  of  the  tongue  a  rare 
aff'ection,  now  that  mercury  is  seldom  used  so  as  to  induce  salivation. 
Generally  an  accompaniment  of  other  diseases,  rather  than  an  idiopathic 
aff'ection. 

Symptoms.  Fever.  Constitutional  disturbance.  Debility.  Anxiety. 
Pain,  heat,  and  salivation.  Color  deepened.  Swelling  sometimes  so 
great  that  cavity  of  mouth  cannot  contain  the  organ,  and  it  projects 
beyond  the  teeth.  Swelling  may  set  in  rapidly  :  often  produces  urgent 
dyspnoea.     Sometimes  ends  in  suppuration. 

Treatment.  Castor  oil,  164.  Castor  oil  and  turpentine  enema,  190» 
Croton  oil  enema,  191.  Chlorate  of  potash,  61.  Application  of  ice. 
Pencilling  with  nitrate  of  silver.  Free  incisions  along  upper  surface 
to  relieve  congestion,  or  evacuate  pus.  Tracheotomy,  if  suffocation 
threaten. 

2.  Ulcers  of  Tongue. — Several  varieties :  most  forms  very  painful  and 
difficult  to  heal. 


256  TONGUE    DISEASES. 

(1)  ^yhole  of  upper  part  of  tongue  sometimes  superficially  ulcerated. 
Eaw  surface  very  tender.  Severe,  long-continued  disorders  of  digestive 
organs  are  chief  source  of  this  form.  May  occur  in  any  disease  attended 
with  great  exhaustion.  To  be  relieved  by  gargles  of  borax,  250.  Nour- 
ishing food,  such  as  can  be  digested.  Tonics  and  stimulants.  Pepsine, 
42Q. — (2)  Ulcers  the  result  of  simple  inflammation  are  usually  small, 
superficial,  without  definite  shape,  very  sensitive.  Seated  about  tip,  or 
near  fi-a3num,  rather  than  at  sides.  Mild  diet.  Simple  aperients,  146,  155, 
161,  169.  Compound  powtler  of  rhubarb.  Borax  gargles,  250.  Appli- 
cation of  sulphate  of  copper.  Extraction  of  carious  stumps.  Removal 
of  tartar  from  teeth. — (3)  Ulcers  from  ptyalism  easily  distinguished  by 
accompanying  affections  of  gums,  and  fetor  of  breath.  Most  readily 
healed  by  chlorate  of  potash,  01.  Sulphate  of  magnesia,  141.  Sulphate 
of  soda,  144,  148.  Chlorinated  soda  gargle,  254.  Alum  and  myrrh 
gargle,  252.  Tannin  gargle,  251. — (4)  Superficial  syphilitic  ulcers  gen- 
erally attended  with  similar  disease  of  lips,  or  other  secondary  symp- 
toms. Appear  at  sides  of  tongue:  very  sore  and  intractable.  Mercurial 
vapor  bath,  131.  Mercurial  inunction.  Green  iodide  of  mercury  and 
conium,  53.  Chlorate  of  potash,  61.  Iodide  of  potassium,  31.  Appli- 
cation of  nitrate  of  silver,  or  sulphate  of  copper. — (5)  Deep  syphilitic 
ulcers  generally  commence  as  inelastic  indurations,  which  slough  in 
centre.  Sores  become  deep  and  excavated  :  edges  ragged  and  sloughy, 
or  thickened  and  hard.  Most  common  on  upper  and  back  part  of 
tongue-  Generally  accompanied  by  other  tertiary  symptoms.  Iodide 
of  potassium,  31.  Corrosive  sublimate  gargle,  25!3.  Nitric  acid  gargle. — 
(6^  R'.Ma,§,t*iing  forms  of  ulc3ration  are  either  strumous,  tuberculous,  or 
eancero'its.  Occur  with  other  symptoms  of  these  diseases.  Require  the 
treatment  necessary  for  constitutional  state.  Cod-liver  oil  generally 
useful. 

3.  Cancer  of  Tongue. — May  be  of  Epithelial  form:  or  a  firm  Scirrhous 
tumor:  or  Medullary.  Of  whichever  kind,  there  is  a  tendency  to  speedy 
ulceration.  A  foul  sloughy  sore  forms,  with  ragged  everted  edges  and 
an  indurated  base. 

Symptoms.  Severe  pain.  Profuse  salivation.  Cancerous  cachexia. — 
Difiicult  articulation  and  deglutition.  Attacks  of  hemorrhage.  Great 
swelling  of  whole  organ.  Sometimes  sloughing.  Cancerous  deposits 
in  sublingual  and  submaxillary  glands:  in  surrounding  tissues.  Mouth 
may  get  almost  filled  with  an  extensive  ulcerated  fungus,  threatening 
sutt'ocation.  Disease  runs  a  rapid  course.  Death,  generally  from  ex- 
Ihaustion. 

Treatment.  Morphia,  315,  843.  Opium  and  belladonna,  344.  Sub- 
cutaneous injection  of  morphia,  atropine,  or  aconitine,  314.  Gargle  of 
citric  acid  (gr.  10  to  fl.  oz.  j).  Milk;  cream;  raw  eggs.  Essence  of 
beef,  3. — To  check  hemorrhage,  application  of  powdered  matico  leaf; 
ice;  lemon-juice;  saturated  solution  of  perchloride  of  iron — Removal 
of  tongue,  by  knife,  ligature,  or  ecraseur.  To  diminish  sensibility  and 
salivation,  division  of  gustatory  nerve.  Division  of  nerve,  with  liga- 
ture of  corresponding  lingual  artery. 

4.  Cracked  Tongue,  Tumors,  &c. — (1)  Cracked  fow^r/e  very  troublesome. 
The  cleCts  or  fissui-es  form  an  irregular  series  of  grooves:  they  may  bo 
.a  couple  of  lines  in  depth.  Render  eating  and  speaking  painful. 
Where  this  condition  cannot  be  accounted  for  by  an}'  specific  state  of 
system,  or  by  any  derangement  of  alimentary  organs,  it  may  often  be 
•cured  l)y  application  of  l)orax  and  glycerine,  268.  Iodide  of  potassium, 
with  steel  or  sarsaparilla,  31,  32. — (2)  Surface  of  tongue  occasionally 
presents  patckea  of  b(ddne.s^,  i.e.,  one  or  more  smooth,  oval,  gloss}'  patches. 


TONSILLITIS.  257 

No  ulceration  or  fissure.  Often  coexists  with  psoriasis  palniaris: 
may  be  indicative  of  a  syphilitic  taint.  Corrosive  sublimate.  27.  ]{ed 
iodide  of  mei'cury,  54.  Donovan's  triple  solution,  51. — (3)  Warts  and 
condylomata  not  uncommon  diseases  of  mucous  covering  of  tongue. 
The  former  requires  excision:  the  latter,  anti-syphilitic  remedies. — 
Papillary  patches  consist  of  large,  tough,  brawny,  coai-sely  jjapillary,  and 
perhaps  fissured  spots  of  thickened  mucous  and  submncoiis  tissue. 
They  cause  an  unpleasant  feeling;  thickness  of  speech  ;  and  have  been 
mistaken  for  cancer.  Iodide  of  potassium,  31.  Conium,  SHG. — (4) 
Hypertrophy,  a  rare  affection  of  tongue.  Sometimes  congenital.  En- 
largement generally  becomes  so  great  that  mouth  is  too  small  ;  conse- 
quently a  large  portion  of  the  organ  is  constantly  protruded.  In  some 
instances,  j)rolapsed  part  has  reached  below  the  chin.  Removal  may  be 
accomplished  by  knife,  ligature,  or  ecraseur. — (5)  When  frajnum  lingua? 
is  shorter  than  usual,  the  individual  is  said  to  be  tongue-tied.  If  move- 
ments of  tongue  be  interfered  with,  the  frsenum  is  to  be  divided;  the 
points  of  scissors  being  directed  downwards  to  avoid  ranine  arteries. — 
(6)  Encysted  or  fatty  tumors  form  in  tongue,  or  beneath  it.  Maj'  require 
extirpation. — Firm  tumors,  made  up  of  fibrous  and  areolar  tissue,  some- 
times grow  from  tongue.  When  pedieulated  they  may  be  snip])ed  off: 
if  an}-  artery  be  felt  in  stalk,  ecraseur  to  be  used. — (7)  Eanula  (from 
Sana,  a  frog;  because  the  voice  is  said  to  be  croaking  like  a  frog's)  is  a 
semi-transparent  fluctuating  swelling,  perhaps  as  large  as  a  walnut, 
situated  under  the  tongue.  It  consists  of  a  dilatation  of  Wharton's 
duct  of  submaxillary  gland.  A  seton  should  be  passed  through  cyst; 
or  a  portion  of  anterior  wall  excised. 

TONSILLITIS.— From  Tonsilla,  the  tonsil;  terminal  -iti's.  Synon. 
Cynanche  Tonsillaris;  Arnygdaiitis ;  Injlammatio  Tonsillarum ;  Quinsy; 
Inflammatory  Sore  Throat. — Inflammation  of  one  or  both  tonsils,  with 
fever. 

1.  Acute  Tonsillitis. — Generally  caused  by  cold  and  some  peculiar 
condition  of  sj'stem.  Liability  to  the  inflammation  increased,  durino- 
youth,  by  repetitions  of  attacks. 

Symptoms.  Chilliness  or  rigors.  Smart  fever.  Redness  and  swelling 
of  fauces  and  tonsils.  Pain  and  difficulty  of  deglutition.  Return  of 
liquids  through  nostrils,  on  attempting  to  swallow.  Pain  along  course 
of  Eustachian  tube. — May  end  in  resolution  in  about  four  days;  often 
goes  on  to  suppuration. 

TreaTiMENT.  Rhubarb  and  magnesia,  165.  Citrate  of  magnesia,  169. 
Solution  of  acetate,  or  citrate,  of  ammonia,  348,  349,  362.  Carbonate 
of  ammonia,  361,  364.  Ammonia  and  bark,  371.  Quinine  and  nitric 
acid,  379.  Guaiacum.  Inhalation  of  steam  of  poppy-water.  Opiate 
gargles,  253.  Linseed  or  hemlock  poultices.  Belladonna  and  opium  to 
outside  of  throat,  297. — If  an  abscess  form,  it  is  to  be  opened  cautiously 
with  a  sharp-pointed  bistour}^,  the  cutting  edge  being  directed  towards 
mesial  line  of  body  :  in  event  of  hemorrhage,  a  strong  solution  of  per- 
chloride  of  lime  to  be  freely  ap]>lied. 

2.  Chronic  Enlargement  and  Induration. — May  result  from  acute  ton- 
sillitis, or  may  come  on  gradually  in  strumous  children  and  wx^akly 
young  women.  Enlargement  often  so  great  that  fauces  appear  to  be 
almost  blocked  up  by  meeting  of  the  glands.  Thickness  of  speech. 
More  or  less  deafness.  Difficulty  in  swallowing.  Impediment  to  full 
and  deep  inspirations. — Iodide  of  ammonium,  38.  Cod-liver  oil.  These 
remedies  failing, — portions  of  the  glands  to  be  excised.     Sometimes, 

17 


258  TOOTHACHE. 

entire  gland  can  be  shelled  out  with  finger.     Applications  of  nitrate  of 
silver,  iodine,  or  potassa  fusa  have  been  recommended. 

Cancer  of  tonsil  may  occur  as  a  secondary  affection.  As  a  primary 
disease  it  is  almost  unknown.  AVhere  suffocation  threatens,  the  promi- 
nent part  of  the  gland  should  be  excised  if  the  whole  cannot  be  shelled 
out. 

TOOTHACHE. — Synon.  Odontalgia;  Odontodynia;  Dentium  Dolor; 
Gomphiasis. — Teeth '^  divided  into  incisors,  canines,  biscuspids  or  pre- 
molars, and  molars.  A  representation  of  the  number  of  different  kinds 
of  teeth  in  both  jaws  by  means  of  symbols,  constitutes  a  "  dental  form- 
ula." Number  and  nature  of  permanent  teeth  of  man  are  thus  expressed 
in  convenient  signs  (Owen)  : 

.  2—2  1—1  2—2  3—3     „„ 

t.  ;  c.   ;  p.  :  m.  =J2. 

2—2  1  —  1  2—2  3—3 

The  formula  for  deciduous,  temporary,  or  milk  teeth  is 

2 2  1 1  2 2 

d  i. ;    d  c.  . ;  d  m. 1^=20. 

2—2  1—1  2-2 

1.  Toothache  from  Caries. — Synon.  Odontalgia  Cariosa ;  Dental  Gan- 
grene.— Softening  and  decay  of  dentine,  causing  great  pain  when  central 
cavity  of  tooth  is  reached.  May  be  due  to  original  malformation  of 
enamel  and  bone,  to  pregnancy,  to  use  of  mercury,  to  depi-aved  secre- 
tions with  dyspepsia,  &c. 

Treatment.  Eemoval  by  scraping  of  decayed  portion,  and  then 
stopping  with  gold,  gutta  percha,  or  amalgam  of  silver  and  mercury. 
Temporary  stoppings  with  cotton-wool  dipped  in  mastic  varnish;  cotton- 
wool with  creasote,  &c.  Extraction.  Troublesome  hemorrhage  after 
extraction  may  set  in  :  Remove  clot  from  cavity,  and  sponge  the  latter 
dry  with  lint  pushed  into  it;  then  plug  with  cotton-wool  soaked  in  a 
saturated  solution  of  perchloride  of  iron,  or  of  tannic  acid,  orof  matico; 
and  finally  add  a  small  compress  of  lint  so  as  to  keep  up  pressure  when 
the  jaws  are  closed.  In  caries  of  deciduous  teeth  extraction  unneces- 
sary, unless  there  be  pain  or  frequent  gum-boils. 

2.  Toothache  from  Inflammation  of  Pulp — Synon.  Odontitis;  Odonto- 
phlegmone. — When  the  pulp  has  been  bared,  inflammation  may  be  set  up 
by  irritation  of  food,  cold,  hot  or  cold  fluids,  &c. 

Treatment.  Aperients,  141,  144,  148,  153.  Washing  mouth  with 
strong  solution  of  bicarbonate  of  soda  in  hot  water.  Stopping  tooth 
with  cotton-wool  saturated  with  creasote,  or  chloroform,  or  oil  of  cloves, 
or  tincture  of  aconite,  or  cajuput  oil,  or  camphor  in  turpentine,  or  tannic 
acid  in  ether.  A  leech  to  gum.  Chewing  horseradish  or  ginger.  Chew- 
ing pellitory  (pyrethrum).  Ginger  poultice  to  face.  Extraction.  Drill- 
ing into  pnl]i-cavity  (rhizodontrypy)  after  sto2)ping. 

3.  Toothache  from  Necrosis  of  Fangs. — The  crown  and  cervix  may  be 
healthy,  and  yet  the  fangs  necrosed.  The  fangs  of  stumps  get  attected 
in  .><ame  Avay.  Abscess  foi-ms  again  and  again.  Instead  of  necrosis 
there  may  be  thickening  of  fang  from  bony  deposit.  Even  exjjosure  of 
.a  fang  from  recession  of  the  gum  causes  often  severe  pain. 

Treatment.  Exti'action.  Sensibility  of  a  bared  fang  may  be  per- 
manently relieved  by  painting  with  carbolic  acid,  or  niti*ate  of  silver. 

4.  Toothache  from  Neuralgia. — Synon.  Odontalgia  Nervosa;  Neuralgia 
Dentalis. —  Not  uncommon  in  early  months  of  pregnancy :  in  cases  of 
disordered  health,  &c.     Rheumatic  toothache  of  same  kind. 


TORTICOLLIS TRICIIINIASIS.  259 

Treatment.  Antacid  aperients.  Quinine.  Animoniated  tincture  of 
valerian  and  bark.  Ammonia  and  sunibul.  Colchicum.  Aconite.  Iodide 
of  potassium.  A  leech  to  tender  gum,  or  scarification.  Eemoval  of 
accumulated  tartar  (salivary  salts — chiefly  phosphate  of  lime). 

TORTICOLLIS.— From  Torqneo,  to  turn  aside;  collnm,  the  neck. 
Synon.  CoUum  Obstipum;  Cephaloloxia ;  Rheumatismus  Cervicis ;  Stiff- 
JVeck. — See  Wry-neck. 

TOXEMIA. — From  To^uov,  a  poison ;  a£,aa,  blood.  Synon.  Toxico- 
hcemia  ;  Toxiccemia. — A  contaminated  state  of  blood,  from  absorption  of 
some  deleterious  matter, — as  syphilitic  virus,  poison  of  small-pox,  ty- 
phus, &c. 

TRACHEITIS.— From  Trachea,  the  wind-pipe;  terminal  -His.  Inflam- 
mation of  the  trachea. — See  Croup. 

TRICHIASIS. — From  0p\^,  rpr/uc;,  the.  hair.  Synon.  Morbus  Pilaris ; 
Trichiasis  CUiorum;  Trichosis  ;  Trichia. — An  irregular  direction%f  one 
or  more  of  the  eyelashes.  The  cilia  present  their  points  towai'ds  the 
globe  of  the  eye,  producing  chronic  inflammation  of  the  conjunctiva. 

Treatment.  Misdirected  hairs  to  be  drawn  out  singly,  with  broad- 
pointed  and  well-gi-ooved  forceps.  Hair  follicle  to  be  destroyed  by  ni- 
trate of  silver;  frequent  dabbing  with  spirits  of  wine. 

TRICHINIASIS. — From  BplS,  rpi'/o:;,  a  hair, — owing  to  the  hair-like 
form  of  the  entozoon  producing  this  disease.  Synon.  Trichina  Disease; 
Trichinosis;  Flesh-Worm  Disease. — A  peculiar  febrile  helminthic  affec- 
tion, attended  with  sjnnptoms  somewhat  resembling  those  of  typhoid 
fever. — Trichinje  may  exist  free  in  muscular  tissue,  or  in  more  or  less 
calcified  cysts  about  ^\-^  of  an  inch  long  and  jJ^  of  an  inch  broad. 
Young  trichina,  extracted  from  cyst,  is  disposed  in  two  or  two  and  a 
half  coils  :  straightened  out,  it  measures  3L  of  an  inch  in  length,  and 
7^1^(5  of  an  inch  in  diameter.  Fully  developed  and  sexually-mature 
male  trichina  measures  j'g  of  an  inch  :  female,  |  of  an  inch. 

Symptoms.  Vary  in  severity  according  as  few  or  many  worms  have 
been  swallowed,  as  well  as  in  proportion  to  number  of  the  progen}"^  and 
extent  of  their  migrations.  Usually,  loss  of  appetite,  general  malaise; 
followed  by  nausea,  prostration,  diarrhoea,  and  painful  stiffness  with- 
swelling  of  muscles  of  arms  and  legs.  Pain  due  to  immigration  of 
young  trichiufe  into  the  muscles.  High  fever:  oedematous  swelling 
about  face  and  eyelids.  Frequent  pulse.  Copious  offensive  sweats. 
Diminished  secretion  of  urine:  excess  of  urates  and  uric  acid,  but  never 
any  albumen  or  sugar.  Stiffness  of  limbs  increases :  muscles  become 
painful,  tender  to  touch,  and  greatly  swollen.  Movements  of  intercostal 
muscles  in  respiration  attended  with  pain,  preventing  sleep.  Hiccup, 
if  diaphragm  be  invaded.  Hoarseness  and  loss  of  voice,  where  laryn- 
geal muscles  get  inhabited. — When  a  large  quantity  of  trichinous  meat 
has  been  eaten,  patient  may  lie  almost  paralyzed  in  state  of  great  ex- 
haustion. Facial  oedema  continues  a  week  or  ten  days:  its  disappear- 
ance followed  by  swelling  of  feet  and  legs  and  trunk. — About  com- 
mencement of  fourth  week,  patient's  condition  very  unfavorable.  Pulse 
and  respirations  frequent:  tongue  dry  and  red  :  pain  severe:  sweating 
profuse:  mouth  can  scai'cely  be  opened:  no  sleep  can  be  obtained:  pra?- 
cordial  anxiety  and  delirium  :  death  preceded  b}^  profound  exhaustion. 
Complications  sometimes  prove  fatal  earlier, — pneumonia,  pleurisy, 
peritonitis,  dropsy,  diarrhoea,  &c.    In  favorable  cases,  symptoms  gradu- 


260  TRISMUS    NASCENTIUM — TUBEHCULOSIS. 

ally  abate;  return  of  appetite  and  power  of  digestion,  dimiBUtion  of 
muscular  pain  and  swelling,  lessening  of  anaemia:  parasites  have  be- 
come encysted  in  the  muscles. 

Treatment.  Very  unsatisfactory.  In  earliest  stage,  emetics  and 
purgatives.  Calomel  and  jalap,  140.  Calomel,  as  a  purgative,  in  20  gr. 
doses.  Prussic  acid,  or  laurel  water.  Quinine.  Picrate  of  potash? 
Benzole?  Oil  of  turpentine  ?  Santonin?  Tannin?  Salts  of  copper? 
For  relief  of  sleeplessness  and  sweating,  wet-sheet  packing,  1H6.  Opium 
and  digitalis,  injurious. — Perfect  quiet.  Broths,  gruel,  milk,  ice,  soda 
water,  brandy  and  egg  mixture  (17),  restorative  soup  (2).  Subse- 
quently, during  convalescence,  large  quantities  of  nourishing  food,  wine, 
&c.     Ferruginous  tonics. 

TRISMUS  NASCENTIUM.— From  7>j'>,  to  gnash  with  the  teeth: 
Nascor,  to  be  born.  Popularly  known  as  Nine-day  fits. — A  peculiar  foi-m 
of  Tetanus,  which  occurs  in  infants  about  second  week  after  birth,  and 
is  ver}^  fatal.  Pare  in  this  country.  Eighty  years  ago,  w^hen  Dublin 
Lying-in  Hospital  was  badly  ventilated,  it  proved  one  of  the  most  prom- 
inent causes  of  infantile  mortality  in  that  Institution.  Still  common 
in  West  Indies,  where  it  sometimes  seems  to  rage  as  an  epidemic. 

When  prevalent,  great  care  necessary  to  guard  new-born  child  from 
cold  or  foul  air,  inij^roper  feeding,  imperfect  cleansing,  or  from  reten- 
tion of  meconium.  Remains  of  umbilical  cord  to  be  properly  managed, 
and  not  left  to  charge  of  an  ignorant  nurse.  In  dividing  funis  at  birth, 
not  more  than  two  inches  to  be  left  attached  to  umbilicus.  As  curative 
remedies,  warm  baths,  purgatives,  and  friction  of  spine  with  belladonna 
are  the  only  measures  likely  to  be  serviceable. 

TUBERCULOSIS. — From  Tuberculum,  dim.  of  Tvher,  a  knob  or  ex- 
crescence.— The  term  tuberculosis  designates  an  idiopathic  blood  dis- 
ease, which  manifests  itself  by  producing  conditions  commonly  known 
as  scrofula,  pulmonary  consumption,  tubercular  hydrocejjhalus,  tuber- 
cular peritonitis,  and  tabes  mesenterica.  Precise  nature  of  change  in 
blood,  unknown;  probably  the  aqueous  part  is  increased  in  proportion 
to  the  solids,  while  the  red  corpuscles  are  especially  diminished. 

Tubercle,  or  tuberculous  matter,  is  the  specific  product  of  this  disease. 
It  is  deposited  in  a  fluid  state  from  the  capillaries,  just  as  lymph  is;  the 
deposit  coagulating,  and  forming  a  foreign  body.  Hence  it  exists  in 
insoluble  masses,  or  is  infiltrated  into  the  tissues  of  many  different 
organs;  being  most  frequently  found  in  the  lungs,  constituting  pulmo- 
nary tuberculosis,  or  tubercular  disease  of  the  lungs,  or  phthisis,  or  con- 
sumption— these  terms  being  synonymous. 

Symptoms.  Dyspepsia,  with  difficulty  in  assimilating  sugar  and  fat. 
Acid  eructations,  heartburn,  flatulence.  Paleness  and  sense  of  coldness 
of  the  body,  although  the  thermometer  shows  an  elevation  of  tempera- 
ture. Tumidity  of  the  abdomen.  Intellectual  system  well  developed. 
Sanguine  temperament.  Pufflness  of  the  face,  with  swelling  of  lips  and 
nostrils.  Purulent  discharges  from  the  ear.  Vesicular  eruptions  about 
the  head.  Enlargement  of  tonsils,  and  glands  of  the  neck.  Disagree- 
able exhalations  from  skin,  especially  from  feet  and  axillae.  Feebleness 
with  rapidity  of  pulse.  General  debility.  Progressive  loss  of  weight. 
Susce|)tibility  to  attacks  of  simple  fever.  Signs  of  disease  in  the  organ 
invaded. 

May  set  in  at  any  period  of  life.  Liability  to  it  greatest  between 
three  and  fifteen,  and  between  eighteen  and  forty. 

Its  development  favored  by  all  conditions  which  render  the  blood 


TYMPANITES — TYPHOID   FEVER.  2i')l 

unhealthy.  Malformations  of  chest.  Defective  structure  of  lungs.  Dis- 
eased nutrition.     Sexual  excesses. 

Treatment.  To  prevent  its  transmission  :  Well-assorted  marriages  to 
be  obtained;  great  care  to  be  taken  of  maternal  health  during  preg- 
nancy-;  attention  to  infant's  food  and  clothing,  as  well  as  to  the  air  it 
breathes.  A  strumous  mother  not  to  be  allowed  to  suckle  her  child. 
Avoidance  of  ill-ventilated,  badly  drained,  or  damp  houses. 

Curative  treatment:  Ini])rovoment  of  the  faulty  nuti-ition.  The  forma- 
tion of  healthy  blood  to  be  promoted.  Special  attention  to  diet,  dress, 
exercise,  repose,  sexual  intercourse,  air  to  be  breathed,  functions  of  skin, 
and  powers  of  the  digestive  organs. — See  Hydrocephalus;  Phthisis; 
Tahes  Mesenterica,  &c. 

TYMPANITES. — From  Ti/mpanum,  a  tambourine  or  drum  ;  because 
the  belly,  if  struck,  sounds  like  a  drum  when  the  bowels  are  distended 
with  air.  SjMion.  Pneumatosis  Abdominis;  Aerosis ;  Meteorism ;  Wind 
Dropsy. — See  Flatulence. 

TYPHLITIS.— From  TucpX^>-,  blind;  terminal -«Y«5.  Synon.  Tuphloen- 
teritis.     Inflammation  of  the  Caecum. — See  Ccecitis. 

TYPHOID  FEVER. — From  Tu<po<;,  stupor;  eWr^c,  appearance.  Literally, 
"like  Typhus." — Formerly  described  as  Abdominal  Typhus;  Febris 
Patrida ;  Gastro-biliovs  Fever ;  Febris  Gastrica;  Febris  Mesenterica  Ma- 
ligna; and  Night-soil  Fever.  In  the  present  day,  its  synonyms  are, — 
Enteric  Fever ;  Pythogenic  Fever;  and  Typhia. — May  be  defined  as  an 
endemic,  slightly  infectious,  contagious  fever ;  most  prevalent  in  autumn  : 
generated  by  putrefying  animal  matter.  Effluvia  from  drains,  or  con- 
tamination of  drinking  water  by  decomposing  sewage  making  its  way 
into  the  wells,  are  frequent  sources  of  this  disorder. — Attacks  rich  and 
poor  indiscriminately ;  but  is  particularly  a  disease  of  early  3'outh  and 
adolescence. — It  frequently  has  a  duration  of  30  days.  In  many  cases 
it  terminates  on  21st  or  28th  day;  and  occasionally  is  followed  by  a 
relapse. 

Symptoms.  Sometimes  a  period  of  incubation,  vaiying  from  10  to  14 
days:  in  other  cases,  the  symptoms  come  on  immediately  after  expo- 
sure to  the  poison.  The  disorder  sets  in  slowly  and  insidiously,  with 
languor.  In  a  day  or  two,  there  are  chills,  headache,  thirst,  pains  in 
limbs,  weakness,  with  a  tendency  to  diarrhciea  and  sickness.  Restless- 
ness ;  face  languid  and  pale,  or  marked  with  a  circumscribed  flush  on 
each  cheek;  urine  diminished  in  quantity,  urea  increased,  chlorides  ab- 
sent; pulse  rises  to  120  or  higher;  breath  offensive,  often  ammoniacal; 
tongue  dry  and  brown,  or  red  and  glazed. — At  commencement  of  second 
week,  or  a  day  or  two  earlier,  the  typhoid  rash  appears;  rose-colored 
dots  on  chest  or  abdomen;  few  in  number;  circular;  disappearing  on 
pressure ;  and  fading  away,  to  be  replaced  by  a  fresh  crop.  In  10  or 
12  per  cent,  no  rash. — After  the  middle  of  the  second  week, — somno- 
lence, delirium,  tinnitus  aurium  or  deafness,  prostration,  bed-sores,  &c. 
Tympanites;  gurgling  in  right  iliac  fossa  on  pressure;  diarrhoea.  At- 
tacks of  hemorrhage  from  the  ulcei-ated  patches  in  the  ileum  and  ca-cum. 
Stools  alkaline  and  of  a  putrid  character.  Perforation  of  the  bowel, 
with  fatal  peritonitis,  to  be  feared.  Congestion  of  kidneys.  Cerebral 
or  pulmonary  complications. 

Mortalit}^  about  1  in  5  or  6.  More  fatal  to  the  rich  than  the  poor. 
Death  usually  due  to  exhaustion,  ura?mia,  peritonitis,  pneumonia,  or 
erysipelas.     Two  lesions  invariably  present, — alterations  in  the  agmin- 


262  TYPHUS    FEVER. 

ated  inlands  or  Payer's  patches,  and  in  the  corresponding  glands  of  the 
mesentery.     Frequently,  the  patches  have  undergone  ulceration. 

Treatment.  Prophylactic:  Good  drainage.  Xo  old  cesspool  to  be 
opened  in  an  inhabited  house.  Patient's  excreta  to  be  passed  into  a 
bed-pan  containing  Condy's  fluid,  74. 

Curative:  In  most  respects  the  same  as  for  typhus.  There  are  two 
or  three  exceptional  points  :  Avoidance  of  aperients.  Astringents  with 
opium  to  relieve  intestinal  irritation  and  diai'rhcea,  96,  97,  100,  105,  106, 
107,  or  113.  Cold  over  the  abdomen  when  there  is  intestinal  hemor- 
rhage ;  gallic  acid,  103. 

Great  care  during  convalescence,  lest  the  cicatrizing  ulcers  in  the 
ileum  be  irritated.  Quinine.  Liquid  extract  of  yellow  cinchona.  Com- 
pound tincture  of  cinchona.  Eeturn  to  a  generous  diet  to  be  very 
gradual :  no  solid  food  until  all  symptoms  have  vanished. 

TYPHUS  FEVER. — From  To(poq,  smoke ;  an  expression  employed  by 
Hippocrates  to  denote  a  lethargic  disease,  in  which  the  patient  is  sud- 
denly deprived  of  his  senses,  as  if  thunderstruck. — Prior  to  1759,  typhus 
was  known  as  Putrid,  Pestilential,  Malignant,  Jail,  Ship,  or  Hospital  Fe- 
ver.— May  be  defined  as, — a  contagious  infectious  fever.  Often  prevails 
epidemically  during  seasons  of  general  scarcity.  The  accompaniment 
of  destitution.  Generated  in  over-crowded  and  ill-ventilated  dwellings. 
Duration  from  1-1  to  21  days. 

vSymptoms.  a  period  of  incubation  varying  from  1  or  2  to  12  days. 
Then,  dry  and  heated  skin;  heavy  dull  look;  thirst;  constipation; 
stupor,  prostration,  &c.  Towards  evening,  irritability  and  restlessness; 
sleepless  nights.  The  typhus  rash  rarely  appears  before  7th  day ;  con- 
sists of  irregular  spots,  of  a  dusky  or  mulberry  hue,  disappearing  on 
pressure,  and  feeling  as  if  raised  above  the  skin ;  remains  permanent 
until  end  of  fever;  may  be  accompanied  by,  or  become  converted  into 
petechiae  ;  sometimes  altogether  absent. 

During  first  week,  deafness  or  noises  in  the  ears;  injected  conjunc- 
tivaB  ;  often  constipation,  never  diarrhoea;  brown  dry  tongue.  Wake- 
fulness ;  or  patient  sleeps,  and  afterwards  believes  he  has  not  done  so. 
Urine  diminished  in  quantity;  urea  increased;  chlorides  absent,  or 
nearly  so;  sometimes  albuminuria;  occasionally  complete  suppression, 
with  urfemia.  In  second  week, — Great  prostration.  Muscular  twitch- 
ing. Delirium.  The  danger  may  be  increased  by  the  supervention  of 
acute  bronchitis,  pleurisy  or  pneumonia.  Approach  of  convalescence 
gradual;  usually  begins  on  18th  or  14th  day.  Sometimes  a  critical 
sleep,  or  sweat,  or  attack  of  diarrhoea,  or  greatly  increased  flow  of  urine. 

When  fatal,  death  usually  occurs  between  12th  or  20th  days.  Mortal- 
ity about  1  in  every  5  attacked.  The  greater  the  age,  the  greater  the 
danger. 

Treatment.  Projihylactic :  The  poor  to  be  supplied  with  wholesome 
food,  and  properly  ventilated  dwellings.  Over-crowding  to  be  pre- 
vented in  sleeping-rooms,  and  lodging-houses.  Every  common  lodging- 
house,  hospital,  workhouse,  &c.,  to  be  thoroughly  cleansed  and  lime- 
washed,  once  a  year  or  oftencr. — Clothes  and  bedding  of  typhus  patients 
to  be  disinfected,  74,  75.  The  patient  to  be  kept  scrupulously  clean. 
Not  to  be  taken  to  the  hospital  in  an  omnibus,  or  street  cab.  No  room 
where  a  case  has  been  to  be  reinhabited  until  purified  with  chlorine  gas, 
whitewashed  or  repapered,  and  had  the  fresh  wind  blowing  through  its 
open  doors  and  windows  for  many  days. 

•  Curative:  Patient  to  be  in  a  well-ventilated  apartment;  free  from 
bed  and  window-curtains,  carpets,  superfluous  furniture;  window  to  be 
open  at  the   top.     A  disinfectant  to  be   used;   chloride  of  lime,  75; 


UREMIA — URINARY   CALCULI.  263 

chloride  of  zinc,  79;  iodine,  81.  A  fire  to  bo  kept  up  in  the  room.  A 
form  of  quarantine  to  be  maintained  strictly. 

Avoidance  of  active  remedies,  at  first  especially,  No  specific  known 
for  cutting  short  the  disease;  quinine  fails,  and  is  often  injurious.  An 
emetic  of  one  ounce  of  ipecacuan  wine,  if  case  be  seen  very  early.  A 
purgative, — from  30  to  60  grains  of  compound  rhubarb  powder.  One 
of  the  mineral  acids,  freely  diluted,  as  a  daily  drink,  357,  358,  359  ;  they 
are  valuable  as  alteratives,  if  the  blood  contain  an  excess  of  ammonia. 
Cold  or  tepid  sponging.  Cold  lotions  to  hea<l.  Cold  affusion,  when 
there  is  a  tendency  to  coma.  Warm  bath,  prolonged  for  30  or  45  min- 
utes, if  there  be  great  irritability.  Milk  diet;  farinaceous  food;  thin 
broths,  well  salted;  tea  and  coffee. 

When  the  powers  of  life  begin  to  fail,  stimulants.  Wine  ;  gin  ;  brandy; 
brandy  and  egg  mixture,  17.  Strong  beef  or  chicken  tea.  Administra- 
tion of  the  nourishment  frequentl}^:  every  30,  45,  or  60  minutes.  Al- 
cohol to  be  used  carefully  when  urine  is  scanty  or  albuminous.  Opium 
to  relieve  restlessness.  Patient  to  be  kept  strictly  in  recumbent  pos- 
ture.    Water-bed.     Catheter,  if  urine  be  retained. 

During  convalescence:  Mineral  acids  and  bark,  376.  Quinine  and 
steel,  380.     A  gradual  return  to  solid  food.     Country  air. 

URJEMIA. — From  Urea;  aqm,  blood. — Toxaemia  from  accumulation 
of  urea  in  the  blood,  owing  to  its  non-elimination  by  the  kidneys. 

SymptoiMS.  Disturbed  action  of  either  or  both  of  the  great  nervous 
centres.     Convulsions.     Coma.     Albuminuria.     Suppression  of  urine. 

Treatment.  Hot  air  or  vapor  bath.  Blanket  bath,  136.  Wet 
sheet  packing,  136.  Acid  sponging,  138.  Saline  aperients,  152.  Jalap 
and  senna,  145,  151.  Elaterium,  157.  Podophyllin,  160.  Croton  oil, 
168,  191.  Castor  oil  and  turpentine  enemata,  190.  Benzoic  acid,  49. 
Lemon-juice.  Yinegar.  Steel.  Arsenic.  Chloroform  vapor,  313.  Stim- 
ulants. Tea.  Venesection?  Cupping  over  loins.  Dry  cupping  to 
nape  of  neck  and  loins.     Ice  to  the  head. 

URETHRITIS.— From  Urethra  (Odpiw,  to  urine) ;  terminal  -itis.  In- 
flammation of  the  urethra  may  be  acute  or  chronic,  may  arise  in  male 
or  female,  and  may  occur  independently  of  gonorrhcea  or  syphilis. 

Symptoms.  Sense  of  heat  along  urethra.  More  or  less  pain  on  uri- 
nating. Muco-purulent  discharge.  Irritability  of  bladder.  Urine  may 
contain  an  excess  of  uric  acid;  sometimes,  blood,  pus,  or  ropy  mucus. 
Lips  of  urethral  orifice  swollen.  Constitutional  disturbance.  May  cause 
retention  of  urine  from  spasmodic  stricture. 

Treatment.  Hot  hip  baths.  Fomentations  and  rest  in  bed,  in  acute 
cases.  Unstiniulating  diet.  Demulcent  drinks.  Opium.  Belladonna. 
Copaiba.     When  chronic,  astringent  injections. 

URINARY  CALCULI.— From  Urina,  iirme:  Calculus  (d'lmm.  of  Cfi]x), 
a  small  stone.  S3'non.  Urolithi. — These  concretions  are  found  in  kid- 
neys, bladder,  or  follicles  of  prostate  gland.  Yery  rarely,  one  or  more 
urinaiy  salts  become  deposited  in  ureters,  or  in  urethra :  usually,  calculi 
found  in  these  situations  have  travelled  there  from  kidneys  or  bladder. 
Calculous  disease  much  more  common  in  men  than  women. 

Chief  Yarieties.  Uric  acid  ;  L^rate  of  Ammonia  ;  Fusible  calculus. — 
Phosphate  of  Lime,  with  Phosphate  of  Magnesia  and  Ammonia ;  Mul- 
berry calculus, — Oxalate  of  Lime;  Carbonate  of  Lime;  and,  very  un- 
common forms,  Cystic  and  Xanthic  Oxides.  Pseudo-calculi  of  tibrine 
or  blood-coagula,  or  of  urostealith  (a  resinous  or  fatty  substance),  are 
exceedingly  rare. 


264  URINARY   CALCULI. 

Calculi  consist  of  only  one  substance,  or  of  alternate  layers  of  two  or 
more  salts — as  of  uric  acid  and  oxalate  of  lime,  &c. 

Urinary  concretions  vary  much  in  size.  Occasionally,  resemble  grains 
of  sand  so  small  as  to  pass  with  urine.  Particles  of  gravel  thus  voided 
may  be  made  up  of  aggregated  crystals  of  urinary  salts, — microscopic 
calculi.  In  other  instances,  calculi  are  as  large  as  a  small  orange.  When 
a  stone  has  formed  in  pelvis  of  kidney,  it  may,  while  of  moderate  size, 
enter  ureter  and  gradually  be  forced  onwards  towards  bladder.  The 
suffering  which  takes  place  during  transit  verj^  great;  popularly  known 
as  "a  fit  of  the  gravel."  As  soon  as  calculus  reaches  bladder,  all  pain 
is  over  for  a  time. 

Symptoms  of  Calculus  Retained  in  Kidney.  Almost  constant  back- 
ache. Bloody  urine,  especially  after  exertion.  Reflex  irritation  of  dis- 
tant organs.  Nervous  irritability.  Subsequently,  impaired  health  :  loss 
of  flesh  and  strength.  Foreign  body  gradually  encroaches  on  true  renal 
tissue  :  either  converts  the  gland  into  a  large  cyst,  or  sets  up  suppurative 
inflammation.  When  large  calculi  are  present  in  both  kidneys,  case 
ends  in  ura^mic  toxsemia. 

Symptoms  op  Stone  in  Bladder.  Severe  attacks  of  pain  in  bladder 
and  perineum:  always  brought  on,  or  aggravated,  by  exercise.  Fre- 
quent micturition,  sometimes  incontinence  of  urine:  with  a  feeling  that 
bladder  is  not  thoroughly  emptied  by  the  act  of  urinating.  Urine  often 
thick  with  ropy  mucus:  sometimes  contains  pus,  or  blood.  Act  of  mic- 
turition often  suddenl}^  stopped  by  stone  being  forced  against  neck  of 
bladder :  on  making  any  movement,  flow  of  urine  returns.  Tenesmus  : 
prolapsus  of  rectum.     Stone  discovered  by  use  of  sound. 

Treatment  OP  Renal  Calculus.  Plain  diet;  nourishing  food,  milk, 
cream,  raw  eggs.  Weak  brandy  or  Avhiskey  and  water.  Free  amount 
of  aqueous  drinks.  Cod-liver  oil.  Belladonna  plasters  to  loins.  Warm 
clothing:  flannel  or  chamois  leather  jackets. — For  checking  hemorrh(xge : 
Gallic  acid,  103.  Tincture  of  perchloride  of  iron,  101,  392.  Iron  alum, 
116.  Pill  of  lead  and  opium.— In  uric  acid  diathesis:  Vegetable  diet: 
white  fish.  Avoidance  of  alcoholic  drinks.  Free  use  of  simple  diluents. 
Yichy  or  Carlsbad  waters.  Acetate  of  potash.  Bicarbonate  of  potash. 
Solution  of  potash.  Citrate  of  potash. — In  phosphatic  diathesis:  Animal 
food.  Wine;  diluted  spirits.  Bark.  Quinine.  Phosphoric  acid.  Nitro- 
hydroehloric  acid.  Steel.  Opium. — In  oxaluria  :  Avoidance  of  garden 
rhubarb,  sorrel  salad,  and  sugar.  Nitro-hj-drochloric  acid.  Tepid  or 
cold  bathing.  Friction  of  skin.  Warm  clothing.  Sea  air.  Attention 
to  digestive  organs. —  To  relieve  ■pain  of  any  form  of  calculus  passing  down 
ureter:  Hot  bath.  Chloroform  or  ether,  inhalation  of.  Opium,  in  full 
doses.  Belladonna.  Barley-water,  or  any  emollient  diluent,  with  spirit 
of  nitrous  ether. 

Treatment  of  Vesical  Calculus  in  Males.  Opium  and  belladonna 
to  allay  pain.  If  stone  be  small,  patient  to  allow  urine  to  accumulate 
and  then  to  discharge  it  forcibly  in  hot  bath.  Introduction  of  silver 
catheter  with  an  ojien  end,  and  washing  out  of  bladder  with  warm 
water.  Lithotrity.  Lithotomy.  Attempts  at  solution  of  calculus 
(Litholysis)  by  alkaline  and  saline  mixtures  in  the  case  of  uric  acid 
calculi,  and  by  acid  solutions  for  oxalate  of  lime  and  phosphatic  calculi, 
have  hitherto  failed.  Injecting  solvents  into  bladder  has  not  succeeded. 
Electi-icity  has  been  employed  foi-  disintegrating  calculi,  but  with  very 
doubtful  results.  That  success  will  ultimately  follow  attempts  at  litho- 
lysis can  hardly  be  doubted. 

Treatment  op  Vesical  Calculus  in  Females.  Four  methods  for 
removal  of  stone:  (1)  Lithotrity:  by  far  the  best  plan,  as  a  general 
rule.     (2)  Dilatation  of  urethra  by  sponge  tents,  or  a  three-bladed  ex- 


URINARY    DEPOSITS — UTERINE   CANCER.  265 

panding  dilator,  or  by  India-rubber  bags  which  can  be  inflated  after 
introduction.  Patient  to  be  under  influence  of  chloroform.  Apt  to  be 
followed  by  permanent  incontinence  of  urine.  (3)  Incision  of  external 
urethral  orifice,  with  stretching  of  canal  by  three-bladed  dilator.  May 
produce  incurable  incontinence.  (4)  Vaginal  lithotomy:  edges  of  in- 
cision into  bladder  being  brought  together  by  silver  wire  sutures,  as  in 
operation  for  vesico-vaginal  fistula. 

URINARY  DEPOSITS. — Two  varieties, — Inorganic  and  Organic.  (1) 
Inon/ii/u'r  Deposits  :  Uric,  or  lithic  acid  ;  amorphous  or  mixed  urates,  con- 
sisting of  uric  acid  combined  with  several  bases — ammonia,  soda,  pot- 
ash, lime ;  urate  of  soda;  urate  of  ammonia ;  hippuric  acid  ;  oxalate  of 
lime;  carbonate  of  lime;  amorphous  phos])hate  of  lime,  or  bone-earth; 
crystallized  phosphate  of  lime,  or  stellar  phosphate;  phosphate  of  am- 
monia and  magnesia,  or  triple  phosphate;  cystine,  or  cystic  oxide; 
xanthine,  or  xanthic  oxide;  leucine  and  tyrosine. 

(2)  Organic  Deposits:  Epithelium  from  pelvis  of  kidney,  ureter,  blad- 
der, urethra,  and  vagina;  epithelium  from  uriniferoiis  tubes,  with  casts 
of  the  tubes  (as  found  associated  with  albuminuria),  such  casts  or  moulds 
of  urinifierous  tubes  being  composed  of  epithelial  cells  imbedded  in  coagu- 
lable  matter,  or  of  an  opaque  granular  matter,  or  of  transparent  waxy 
matter,  or  of  waxy  material  studded  with  minute  fatty  particles,  or  of 
blood  discs,  or  of  pus  corpuscles;  molecular  fatty  matter,  as  in  chyluus 
urine;  oil  globules,  free,  or  inclosed  in  cells,  or  adherent  to  casts;  pus; 
blood;  cancerous  and  tubercular  matter;  spermatozoa;  and  minute 
confervoid  parasitic  vegetations, — sarcinge,  yeast  or  sugar  fungus  (Torula 
cerevisiae),  mould  fungus  (Penicilium  glaucum),  and  vibriones. 

Soluble  substances  found  in  morbid  urine:  Urea,  in  abnormal  quantity; 
albumen  ;  sugar ;  biliary  coloring  matter  ;  and  biliary  acids. 

UTERINE  CANCER. — From  "Ytrripa,  tbe  womb:  Cancer  (xipy.v^ix;,  a 
crab)  a  kind  of  ulcer.  Synon.  Metro-carcinoma;  Carcinoma  Uteri. — Can- 
cer of  the  womb  most  frequently  met  with  under  form  of  medullary  ul- 
ceration of  lips  or  vaginal  portion  of  cervix.  Very  rarely,  infiltration 
commences  in  mucous  or  muscular  coat  of  body  or  fundus  of  womb. — 
Medullary  cancer  most  common  variety.  Scirrhus  seldom  observed. 
Cauliflower  excrescence,  or  epithelioma,  not  often  met  with.  Uterine 
cancer  most  frequent  after  the  40th  year. 

Symptoms.  Abundant  watery  discharge,  of  a  dirty  pale-gi-een  color, 
always  offensive.  Sudden  attacks  of  hemorrhage.  Distressing  pain;  at 
first  most  severe  at  night,  afterwards  always  present.  Nausea  and 
vomiting;  flatulence;  irregular  action  of  bowels;  loathing  for  food. 
Painful  mental  depression.  Daily  increasing  debility,  and  vvaste  of 
tissues.  Dingy  sallow  hue  of  countenance,  and  pinched  anxious  ex- 
pression— cancerous  facies. — Uterus  found  immovably  fixed  in  pelvic 
cavity.  Labia  uteri  indurated  and  nodulated  at  first:  subsequently, 
excavated  by  an  ulcer  of  a  loose  spongy  character,  seated  on  a  hard- 
ened base,  and  sun-ounded  by  indurated  tissue.  Vagina  soon  gets  in- 
volved :  communications  form  between  vagina  and  bladder,  or  vagina 
and  rectum.  Death,  in  course  of  second  year  from  commencement  of 
symptoms,  from  exhaustion. 

Treatment.  General  remedies:  Ammonia  and  bark,  371.  Mineral 
acids  and  bark,  376.  Citric  acid  and  bark.  Phosphoric  acid  and  qui- 
nine, 379.  Quinine  and  belladonna,  383.  Zinc  and  conium,  413.  Cod- 
liver  oil,  389.  Nutritious  diet:  milk  and  cream,  raw  eggs,  animal  food. 
Light  s])arkling  wines;  sherry;  brand3\  Malt  liquors  usually  increase 
dy spejisia.    Avoidance  of  sexual  intercourse. —  When  stornach  is  irritable : 


266  UTERINE    DISPLACEMENTS. 

Pepsine,  420.  Nitro-hj'drochloric  and  dilute  hydrocyanic  acids,  378. 
Ammonia  and  ether,  364.  Bismuth,  112.  Ice.  Cream  of  tartar  drink, 
356.  Chlorate  of  potash  drink,  where  there  is  soreness  of  mouth,  360. 
Castor  oil.  Confection  of  senna  with  taraxacum,  194.  Simple  enemata, 
188.  Belladonna  liniment  to  epigasti'ium.  Sinapisms.  Hemlock  poul- 
tices.— For  relief  of  pain  :  Henbane,  camphor,  and  hop,  325.  Opium  and 
henbane,  343.  Morphia,  chloroform,  and  Indian  hemp,  317.  Subcu- 
taneous injection  of  morphia,  314.  Opiate  enemala,  or  suppositories, 
339,  840.  Oxide  of  zinc  and  belladonna  pessaries,  423.  Use  of  a  frigo- 
ritic  mixture  of  ice  and  salt  to  uterus,  by  a  gutta  percha  speculum.  In- 
jection of  carbonic  acid  gas  :  of  chloroform  vapor.  Belladonna  liniments 
or  phisters  to  sacrum.  Hemlock  poultices  to  pubes  and  vulva. — For 
control  of  hemorrhage :  Gallic  and  aromatic  sulphuric  acids,  103.  Cinna- 
mon, 104.  Iron  alum,  IIG.  Lead  and  opium,  with  acetic  acid,  117. 
Turpentine.  Digitalis.  Application  of  cold  to  vulva.  Insertion  of  plug 
of  wool,  saturated  with  sohition  of  perchloride  of  iron,  into  ulceration. 
Injection  of  solutions  of  alum  and  tannic  acid,  or  of  infusion  of  matico. 
Tannic  acid  pessaries,  423.  Plugging  with  cotton-wool. — For  removal  of 
offensive  odor  in  discharges  :  Cleanliness.  Injections  of  solutions  of  chlo- 
rinated soda  or  lime;  of  creasote  and  water  (fl.  drm.  j.  to  fl.  oz.  xx);  of 
solution  of  permanganate  of  potash  and  water  (fi.  drs.  iv  to  fl.  oz.  xx) ; 
of  chloride  of  zinc  and  water  (gr.  20  to  fl.  oz.  xx).  Pessary  of  logwood 
and  cocoa  butter  (gr.  30  of  each).  Iodoform  pessaries,  423.  Padding 
vulva  w'ith  muslin  bags  of  vegetable  charcoal. 

Operations  by  knife,  ecraseur,  and  ligature,  useless.  Employment  of 
powerful  escharotics  rarely  to  be  recommended.  The  treatment  of  cau- 
liflower excrescence,  in  early  stage,  perhaps  an  exception  to  two  fore- 
going rules. 

UTERINE  DISPLACEMENTS.— The  uterus  may  be  displaced  in  sev- 
eral ways,  giving  rise  to  much  discomfort. 

1.  Prolapsus  and  Procidentia. — Terms  employed  to  designate  a  descent 
of  the  womb  as  it  exists  in  two  diff'erent  grades.  By  "  Prolapsus"  (Pro- 
labor,  to  glide  forward)  is  meant  that  condition  in  which  uterus  falls  be- 
low its  natural  level  in  pelvic  cavity.  By  "  Procidentia"  (Procido,  to 
fall  down)  is  signified  the  protrusion  of  uterus  beyond  vulva.  Causes 
of  both  conditions  the  same.     Suffering  varies  chiefly  in  degree. 

Symptoms.  Sense  of  fulness  or  pelvic  weight.  Bearing-down  pains. 
Backache.  Leucorrhoea.  No  impediment  to  menstruation ;  nor  to  con- 
ception, as  uterus  is  generally  easily  replaced  Avhen  patient  is  in  bed. 
Irritation  of  bladder  and  rectum.  In  prolapsus,  uterus  found  depressed, 
perhaps  resting  on  upper  floor  of  perineum.  In  procidentia,  a  round  or 
pear-shaped  tumor,  with  os  uteri  visible  at  its  centre,  seen  projecting 
beyond  vulva.  Labia  uteri  often  excoriated.  Vaginal  walls  may  be 
dry  and  harsh  and  cracked ;  perhaps,  ulcerated. 

Treatment.  General  rules :  Artificial  suppoi-t  to  be  afforded  to  super- 
incumbent abdominal  viscera.  Tone  to  be  given  to  round  and  broad 
ligaments  of  uterus,  to  relaxed  vaginal  walls,  to  perineum.  Removal  of 
complications, — uterine  congestion  or  hypertrophy,  cough,  constipa- 
tion, &c. 

To  effect  reposition  in  procidentia  :  Patient  to  be  placed  on  left  side, 
with  knees  well  flexed  :  greased  uterus  to  be  gently  pushed  up.  Woman 
may  rest  on  hands  and  knees,  with  head  lower  than  pelvis,  so  as  to  re- 
move superincumbent  weight  of  intestines:  womb  to  be  then  replaced. 
Uterus  to  be  firmly  encircled  with  strips  of  plaster  for  forty-eight  hours, 
and  patient  kept  quiet  in  bed:  circumference  of  tumor  being  thus  re- 


UTERINE   DISPLACEMENTS.  267 

(luced,  reposition  uHunlly  effected  with  case  after  removal  of  plaster. 
All  plans  failing,  uterus  has  been  removed  by  ligature  applied  around 
the  neck  of  tumor  formed  by  it. 

To  support  abdominnl  viscera  :  An  abdominal  belt  of  common  jean.  A 
pelvic  belt,  with  a  firm  perineal  band  and  pad, — a  modification  of  the 
T-bandage.  Hull's  ''  Utcro-abdominal  Supporter."  Bigg's  abdominal 
])late,  fixed  by  steel  bauds  somewhat  like  a  truss. 

To  give  tone  to  tissues:  Phosphoric  or  nitric  acid,  nux  vomica,  and 
bark.  .376.  Tincture  of  perchloride  of  iron,  380,  392,  397.  Quinine  and 
nux  vomica,  387.  Strychnia  and  steel,  408.  Astringent  vaginal  injec- 
tions, 425.  Astringent  pessaries,  423.  Nitrate  of  silver  to  vaginal 
walls.     Cold  salt  water  hip  baths.     Nourishing  diet. 

To  support  uterus:  Oval  or  globular  boxwood,  vulcanized  India-rubber, 
vulcanite,  tin,  plated  or  gilt  metal,  or  gum  elastic  pessaries.  Eing  pes- 
saries. Hodge's  lever  pessaries.  Pessary  of  watch-spring,  covered 
with  thread  and  solution  of  gutta-percha.  Zwauke's  pessary.  Eemoval 
by  dissection  of  one  or  more  longitudinal  strips  of  vaginal  mucous  mem- 
brane, bringing  edges  of  wound  together  with  wire  sutures.  Paring  the 
sides  and  posterior  wall  of  lower  part  of  vagina,  and  keeping  raw  sur- 
faces in  contact  by  quill-suture,  so  as  partly  to  close  vulval  opening. 

2.  Retroflexion  and  Anteflexion. — Eetroflexion  (Reti-o,  backwards; 
Jlecto,  to  bend)  consists  of  a  bending  backwards  of  uterus,  at  part  where 
the  neck  joins  the  body;  so  that  fundus  is  found  between  cervix  and 
rectum,  os  uteri  being  in  normal  position.  Uterus  becomes  shaped 
like  a  retort. — In  anteflexion  {Ante,  forwards;  flecto),  fnndns  rests  on 
bladder. 

Symptoms.  Almost  absent  when  displacement  is  slight,  uterine  struc- 
tures flabb}^  and  pelvic  cavity  more  than  ordinarily  capacious.  Con- 
siderable suffering  where  angle  of  flexion  is  acute,  uterine  ligaments 
unduly  stretched,  circulation  through  uterus  impeded,  and  fundus  im- 
movabl}^  pressed  on  rectum  or  bladder. 

Dull  wearying  backache.  Tenderness  about  groins  and  inside  of 
thighs.  Sense  of  fulness  in  rectum  or  bladder.  Pain  from  sexual  in- 
tercourse:  fecundation  prevented.  Dysmenorrhoea.  Nausea,  loss  of 
appetite,  mental  depression.  Hysteria.  Displacement  recognized  with 
certainty  by  use  of  uterine  sound. 

Treatment.  Eeplacement  by  pushing  fundus  upwards,  with  or  with- 
out assistance  of  uterine  sound.  Use  of  intra-uterine  stem.  Pessaries 
of  belladonna  and  iodide  of  lead  or  mercurial  ointment,  423.  Dilata- 
tion of  uterine  cavity  and  cervix  with  sponge  or  sea-tangle  tents  (426), 
allowing  uterus  afterwards  to  contract  in  normal  position  upon  a  metal- 
lic stem.  Horseshoe-shaped  vaginal  pessaries.  Division  of  os  and 
cervix  with  hysterotome,  so  as  to  remove  contraction  of  muscular  tissue 
at  point  of  flexion. 

3.  Retroversion  and  Anteversion. — In  retroversion  (Betro,  backwards ; 
verto,  to  turn),  uterus  lies  almost  transversely  in  uterine  cavity;  with 
fundus  towards  hollow  of  sacrum,  and  os  uteri  under  pubic  arch.  The 
opposite  condition,  anteversion  {Ante,  forwards ;  verto)  is  characterized 
by  fundus  lying  towards  bladder,  and  os  uteri  in  cavity  of  sacrum. 

Symptoms.  Backache,  bearing  down.  Leucorrhoea.  Menstruation 
not  interfered  Avith  :  impregnation  not  absolutely  prevented.  In  retro- 
version, pressure  of  labia  uteri  on  urethra  may  cause  retention  of  urine, 
— a  common  result  in  pregnancy. 

Treatment.  Occasional  replacement.  Quinine,  steel,  and  nux 
vomica,  380.  Mineral  acids  with  strychnia,  378.  Nourishing  food.  In- 
jections of  alum  and  sulphate  of  zinc,  425.    Tannin  pessaries,  423.    Cold 


268  UTERINE    HEMORRHAGE UTERINE    TUMOR. 

sea-water  baths.  Avoidance  of  over-exertion,  straining  at  stool,  &c. 
In  displacement  during  pregnancy,  reposition  best  eifected  with  patient 
resting  on  hands  and  knees:  chloroform  maj^  be  required.  Use  of 
catheter. 

4.  Inversion  of  Uterus. — From  In,  in;  verto,  to  turn.  Synon.  Tnversio 
Uteri. — The  uterus  is  literally  turned  inside  out.  Fundus  descends 
through  OS  uteri;  mucous  lining  of  cavity  of  womb  becoming  the  ex- 
ternal covering  of  tumor,  which  projects  into  vagina  and  generally 
through  vulva.  Usually  happens  directly  after  labor;  but  has  followed 
the  expulsion  of  a  polypus. 

Symptoms.  Severe  nervous  shock.  Great  depression  and  faintncss. 
Bearing-down  pain.  Nausea  and  vomiting.  Perhaps,  hemorrhage. 
Sometimes  death  from  shock,  especially  if  the  labor  has  been  difficult. 
Where  the  accident  has  not  been  detected  at  time  of  occurrence,  pa- 
tients have  gone  on  for  months,  or  even  years,  sutfering  from  bad 
health,  anaemia,  repeated  attacks  of  hemorrhage,  sacral  and  pelvic 
pains,  &e. 

Treatment.  When  occurring  directly  after  labor,  placenta  to  be 
peeled  off  if  it  remain  attached.  Uterus  to  be  firmly  grasped,  and 
steady  pressure  made  in  upward  direction  so  as  to  reduce  that  portion' 
first  which  has  last  descended  :  patient  may  be  under  influence  of  chlo- 
roform.— In  chronic  cases,  attempts  at  replacement  may  have  to  be 
gently  pei'severed  with  even  for  an  hour  or  rather  longer.  Occasion- 
ally, the  attempt  has  had  to  be  repeated  for  many  days  in  succession; 
pressure  having  been  kept  up  during  the  intervals  by  a  well-adapted 
air  pessary.     All  plans  failing,  uterus  has  been  removed  by  ligature. 

UTERINE  HEMORRHAGE.— Synon.  Ha-morrhagia  Uteri;  Metrorrha- 
gia; Flooding. — Arises  chiefly  from:  Cancer  of  uterus.  Fibroid  tumors 
or  polypi.  Endometritis.  Inflammatory  diseases  of  the  cervix.  Con- 
gestion of  the  ovaries.     Moles. 

Often  the  precursor  of  abortion.  In  latter  months  of  pregnancy,  in- 
dicative of  separation  of  the  placenta;  or  of  placenta  praivia. 

Treatment.     See  Menorrhagia. 

UTERINE  TUMOR. — Synon.  JTysteroncus ;  Metroncus ;  Hysterophyma ; 
MetropJtyma  ;  Tumor  Uteri. — Of  all  organic  diseases  of  uterus  first  mani- 
festing themselves  during  period  of  sexual  vigor,  non-malignant  tumors 
are  the  most  common. 

1.  Fibroid  Tumors. — Consist  of  outgrowths  of  uterine  tissue.  Are 
single  or  multiple.  Sometimes  attain  an  enormous  size.  May  be  de- 
velo])ed  in  an}^  part  of  uterus.  Classified  as  subperitoneal  or  surface 
tumors,  when  just  beneath  peritoneum;  interstitial  or  intra-mural 
tumors,  when  imbedded  in  uterine  walls;  and  submucous  or  intra- 
uterine tumors,  when  pressed  into  cavity  of  wotnb. 

Symptoms.  Often  neither  important  nor  well  marked.  When  of 
sufficient  size  to  encroach  on  pelvic  viscera,  or  to  be  detected  thr-ough 
abdominal  wall,  symptoms  more  prominent.  Menstrual  irregularities, — 
frequently  monorrhagia.  Dull,  aching,  throbbing  pains.  Sense  of 
weight  and  bearing-down.  Cramp  or  numbness  in  one  or  both  thighs. 
Difficulty  in  voiding  or  in  retaining  urine.  Constipation  :  hsemorrlioids. 
Enlargement  and  tenderness  of  breasts.  Attacks  of  severe  hemorrhage 
in  intra-uterine  growths  :  occasionally,  expulsive  pains.  Tumor  detected 
on  careful  abdominal  manipulation,  and  vaginal  examination. 

Treatment.  In  a  large  number  of  cases,  the  less  fibroid  tumors  are 
interfered  with  the  better.     Great  danger  from  attempting  radical  cure 


UTERINE    ULCERATION.  269 

by  enucleation,  gouging  growth  and  scooping  away  portions,  or  by 
abdominal  section. — Remedies  recommended  to  produce  absorption:  Mer- 
cur}';  iodine;  iodide  of  potassium;  solution  of  potash.  Bromide  of 
potassium,  42.  Bromide  of  ammonium,  37.  Chlori|[^  of  calcium.  So. — 
For  control  of  hemorrhage:  Corrosive  sublimate,  27.  Gallic  acid,  103. 
Oxide  of  silver  and  Indian  hemp,  47.  Iron  alum,  116.  Incision  of  os 
and  cervix  utei-i.  Incision  into  exposed  part  of  tumor,  where  it  can  be 
easily  reached  from  vagina. — For  relief  of  pressure  on  pelvic  viscera: 
Gentle  elevation  of  tumor  into  false  j)elvis.  Iodide  of  lead  and  bella- 
donna pessaries,  423. — For  cure  of  siiffering  due  to  congestion  or  oedema  of 
growth:   Bromide  of  potassium,  42.     Kreuznach  waters,  484. 

2.  Polypus  of  Uterus. — From  TloVuq,  many;  ttou?,  a  foot:  'T<T-ipa,  the 
womb.  Synon.  Metropolypus ;  Bysteropolypus ;  Polypus  of  the  Womb. — 
A  tumor  attached  to  inner  surface  of  uterus  by  a  pedicle  or  neck.  May 
occupy  uterine  cavity  or  be  in  vagina  and  merely  attached  to  uterus  by 
pedicle.    Three  varieties:  Fibroid,  mucous  or  gelatinous,  and  placental. 

SyiMptoms.  Profuse  menstruation.  Irregular  attacks  of  uterine 
hemorrhage, — often  amounting  to  flooding.  Profuse  leucorrhoeal  dis- 
charge. Irritation  of  pelvic  viscera  from  pressure.  Spasmodic  attacks 
of  pain.  Debility  and  loss  of  flesh,  in  proportion  to  amount  of  dis- 
charges. Tumor  found  on  making  vaginal  examination  :  if  it  be  in 
uterine  cavit}",  easily  detected  after  dilating  os  by  sponge-tents. 

Treatment.  If  tn  vagina:  Tumor  to  be  removed  b}- dividing  pedicle 
with  scissors  or  wire-rope  ecraseur. — If  in  utero :  Os  uteri  to  be  fully 
dilated  with  sea-tangle  or  sponge-tents  (426),  and  tumor  subsequently 
removed  by  division  of  pedicle  with  wire-rope  ecraseur.  Sometimes, 
can  be  taken  away  by  torsion,  when  pedicle  is  slender. 

3.  Cysts  of  Uterus. — Unilocular  cysts,  or  closed  sacs,  filled  with 
mucus  or  serum,  are  occasionally  developed  in  substance  of  uterus,  or 
just  beneath  internal  mucous  lining,  or  under  external  serous  covering. 
Sometimes,  one  part  of  uterus  invaded  by  cystic  growth,  while  another 
is  the  seat  of  an  ordinary  fibroid  tumor.  These  cysts  only  give  rise  to 
inconvenience  when  they  attain  such  a  size  as  to  admit  of  their  detec- 
tion. If  within  reach,  they  may  be  punctured :  if  pediculated  and 
pressing  into  uterine  cavity,  they  can  be  twisted  off  after  dilating  the 
OS  uteri  with  sponge-tents. 

UTERINE  ULCERATION.— From  'Yaripa.  the  womb ;  Vlcero,  to  cause 
to  ulcerate.  Synon.  Mysterelcosis ;  Uteri  Exulceratio. — As  a  frequent 
result  of  congestion  and  inflammation  of  lower  part  of  uterus,  various 
forms  of  ulceration  are  found  about  the  cervix: 

1.  Simple  Abrasion. — S3'non.  Excoriation .,  or  Erosion,  of  Labia  Uteri. — 
Epitheliuiu  removed  from  a  part  of  one  or  both  lips;  exposed  villi  with 
tlieir  looped  capillaries  conveying  a  '•  velvety"  feel  to  the  touch.  Extent 
of  abrasion  easily  ascertained  with  speculum. 

Symptoms.  Leucorrha-al  discharge.  Pelvic  and  sacral  pains.  Ovarian 
iri'itation.  Indigestion  :  flatulence,  with  irregular  action  of  bowels. 
Irregular  menstruation.     Depression  of  general  health. 

Treatment.  Locally:  Alum  or  zinc  injections,  425.  Te])id  or  warm 
salt  water  hip  baths.  Iodide  of  lead  and  belladonna,  or  acetate  of  lead 
and  opium  pessaries,  428.  Application  of  solid  nitrate  of  silver.  L^ndi- 
luted  solution  of  subacetate  of  lead.  Glycerine.  Collodium.  2^<5.  Mer- 
curial ointment.  Acid  solution  of  nitrate  of  mercury.  Potassa  fusa. 
Scarification  of  labia,  or  application  of  three  or  four  leeches  where 
there  is  congestion. 


270  URTICARIA. 

Generally :  Animal  food  :  milk.    Claret,  sherry,  champagne,  or  brandy 

*and  water, — in   place  of  malt  liquors.      Nitro-hydroehloric  acid,  378. 

Salicin,  388.     Quinine,  379.     Pepsine,  420.     Rhubarb  and  ipecacuanha, 

179.     Oxide  of  sil^Pr,  47.     Arsenic  and  bark,  52.     Iodide  of  potassium, 

31.     Cod-liver  oil.     Moderate  exercise  in  open  air. 

2.  Ulceration  of  Labia  Uteri. — Uterine  lips  not  only  more  or  less 
dejDrived  of  dense  epithelium,  but  the  villi  with  their  vascular  loops 
destroyed  in  patches.     Sometimes,  proper  tissue  of  uterus  involved. 

Symptoms.  Thick  muco-purulent  discharge.  Pelvic  pains.  Back- 
ache. Menorrhagia.  Anaemia:  headache,  neui'algia,  dirty  sallow  hue 
of  skin,  irregular  action  of  bowels,  loss  of  appetite,  &c.  Debility  : 
mental  depression.  Pains  increased  by  walking  or  sitting  upright. 
Reflex  irritation  of  breasts,  bladder,  and  rectum. 

Treatment.  Same  as  for  simple  abrasion.  Warm  water  or  stringent 
injections  night  and  morning.  Tonics.  Nourishing  food  :  stimulants. 
Relief  to  reflex  irritation  by  iodide  of  lead  and  belladonna  j^essaries, 
423.     Avoidance  of  sexual  intercourse. 

3.  Syphilitic  Affections. — Primary  syphilitic  sores  very  rare.  Chancre 
may  be  situated  on  labia,  within  canal  of  cervix,  or  on  outside  and 
upjjer  part  of  cervix. — Secondary  syphilitic  affections  of  uterus  not  un- 
common. Chief  symptoms, — Hypertro])hy  and  induration  of  vaginal 
portion  of  cervix.  Abundant  muco-purulent  discharge  from  uterus  and 
vagina.  Patches  of  abrasion,  or  of  ulceration  on  labia  uteri.  Menstrual 
irregularities, — often  menorrhagia.  Evidence  of  disease  in  distant 
parts,  loss  of  hair,  sore  throat,  cutaneous  eruptions,  nodes,  &c.  Treat- 
ment the  same  as  for  syphilis  generally. 

4.  Rodent  Ulcer. — Synon.  Corroding  Ulcer. — A  severe  disease,  which 
has  been  confounded  with  epithelial  cancer.  Very  rare  befoi'e  age  of 
thirty;  usually  commences  about  "change  of  life." 

Symptoms.  Ulceration  begins  gradually  and  extends  slowly.  As  it 
eats  away  aff'ected  tissue,  complaint  made  of  pelvic  heat  and  discom- 
fort; thin  serous  discharge,  occasionally  streaked  with  blood.  Debility, 
pallor,  indigestion.  Subsequently, — burning  pains;  attacks  of  hemor- 
rhage. On  examination,  an  irregularly-sha})ed  ulcer  found,  with  ragged 
or  indurated  edges :  sore  excavated,  presenting  a  dry  and  glossy  or  a 
pulpy  surface.  Uterus  not  fixed,  as  in  cancer.  Sometimes,  whole  of 
cervix  destroyed.  Disease  eats  its  way  into  body  of  uterus;  so  that 
entire  muscular  structure  gets  destroj^ed,  unless  death  first  occur  from 
hemorrhage  or  peritonitis  or  exhaustion. 

Treatment.  Excision,  if  disease  be  limited  to  cervix  :  otherwise, 
actual  cautery,  or  potential  caustics.  Sedative  vaginal  injections,  425. 
Opium  and  belladonna  pessaries,  423.  Arsenic,  52.  Cod-liver  oil.  Tonics. 
Narcotics.     Nourishing  food. 

URTICARIA. — From  Urtica,  a  nettle.  S^^non.  Purpura  Urticata ;  Ex- 
anthema Urtiaituin;  jVettle-Pash. — A  non-contagious  aftcction  of  the  skin. 
One  of  the  Exanthemata.  Characterized  by  formation  of  ])r()mincnt 
patches  or  wheals  (pomphi),  which  often  apjiear  and  disappear  sud- 
denly: accompanied  by  heat,  burning  with  tingling,  and  great  itching. 
'Sometimes,  constitutional  disturbance:  fever,  coated  tongue,  unhealthy 
secretions.  A  chronic  intermittent  variety  (Urticaria  Evanida  of  Wil- 
lan),  often  very  troublesome,  lasting  for  months. 

Urticaria  generally  due  to  derangement  of  digestive  organs,  caused 
by  use  of  shell-fish,  mushrooms,  cucumbers,  nuts,  bitter  almonds.  Hen- 
bane, turpentine,  nux  vomica,  and  balsam  of  copaiba  may  induce  it. 


VACCINIA VAGINAL  PROLAPSUS.  271 

Sometimes  connected  with  rheumatism  or  gout,  uterine  irritation,  den- 
tition, &c. 

Treatment.  Sulphate  of  magnesia  in  acid  infusion  of  roses,  142. 
Ehubarb  and  magnesia,  165.  Khubarb  and  blue  pill,  171.  Ammonia 
and  chiretta,  63.  Bismuth,  65.  Potash  and  ammonia,  67.  Ammonia 
in  effervescence,  362.  Nitro-hj-drochloric  acid,  378.  Steel  and  ammonia, 
401.  Steel  and  citrate  of  potash,  403.  Pe])sine,  420.  Iodide  of  potas- 
sium and  colchicum  (in  chronic  form).  Quinine,  379.  Arsenic,  52. 
Sponging  with  vinegar  and  water:  equal  parts  of  tincture  of  ai-nica, 
glycerine,  and  rose-water:  equal  parts  of  solution  of  sul)acetate  of  lead, 
laurel  water,  glycerine,  and  elder-flower  water:  solution  of  cori-osive 
sublimate  (gr.  5  to  fl.  oz.  viij).  Warm  or  tej)id  baths.  Plain  diet.  Active 
exercise. 

VACCINIA. — From  Vacca,  a  cow.  Synon.  Variola  Vaccina;  Exan- 
thema Anticariolosum;  Vacciola ;  Inoculated  Cow-Pox.  —  A  disease  pro- 
duced by  inoculation  with  the  virus  of  cow-pox,  such  disease  aflfVjrding 
protection  against  the  contagion  of  small-pox.  Included  by  Willan  in 
the  Vesicular  order  of  skin  diseases. — See  Cow-Pox. 

VAGINAL  OCCLUSION.— From  Vagina,  a  sheath  or  scabbard.— In- 
dependently of  cases  where,  from  arrest  of  development,  vagina  is  en- 
tirely absent,  or  is  considerably  malformed,  examples  of  occlusion  can 
be  arranged  under  one  of  three  heads : 

(1)  Those  where  there  is  a  morbidly  tough  and  persistent  hymen.  If 
the  membrane  cannot  be  ruptured  with  finger,  it  must  be  divided;  re- 
union being  prevented  by  use  of  oiled  lint.  (2)  Where  the  hymen  is 
hypertrophied  and  imperforate,  so  as  completely  to  close  vaginal  canal 
from  urethra  to  fourchette,  preventing  escape  of  menstrual  fluid.  A 
longitudinal  or  crucial  incision  to  be  made  through  obstructing  mem- 
brane. Under  such  conditions,  operation  attended  with  considerable 
danger  :  fatal  peritonitis,  endometritis,  or  pyaemia  not  uncommon.  And 
(3)  cases  of  imperforate  vagina;  whether  due  to  congenital  adhesions 
between  opposite  walls,  to  stricture  in  consequence  of  inflammation,  or 
to  cicatrices  consequent  on  injury.  A  careful  dissection  often  required 
to  make  canal  patulous. 

VAGINAL  PROLAPSUS.— From  Vagina,  a  sheath  :  Prolabor,  to  fall, 
or  slip  out.  Synon.  H yder opt osis  Vagina'. ;  Colpoptosis ;  Elytroptosis. — A 
descent,  more  or  less  complete,  of  the  vagina. 

Sy.mptoms.  Protrusion  of  the  vagina  usually  accompanied  by  pro- 
lapsus uteri,  though  it  may  occur  alone.  If  entire  circumference  of 
vaginal  mucous  membrane  be  prolapsed,  a  projecting  tumor  is  found  at 
vulva.  Surface  may  be  inflamed  and  excoriated.  Bladder  rendered 
irntable  :  often,  emptied  with  difficulty. 

Cases  of  partial  more  common  than  of  complete  prolapsus.  When 
anterior  wall  is  alone  affected,  posterior  wall  of  bladder  is  drawn  down — 
Vaginal  cy&tocele.  The  posterior  Wall  of  vagina  and  anterior  wall  of 
rectum  may  be  protruded — Vaginal  rectocele.  In  the  one  case,  urine  is 
apt  to  accumulate  in  pouch  formed  by  bladder;  in  the  other,  a  pocket 
forms,  in  which  hard  fecal  masses  ai'e  retained,  causing  constipation  and 
sense  of  weight. 

Treatment.  6^eA?em%.-  Nourishing  food.  Eest.  Avoidance  of  strain- 
ing, and  of  lifting  heavy  weights.  Quinine,  steel,  and  strychnia,  380. 
Phosphoric  acid,  nux  vomica,  and  bark,  876.  Phosphate  of  zinc  and 
steel,  or  bark,  414.  Sulphate  of  zinc  and  nux  vomica.  409.  Colocynth, 
or  aloes,  and  nux  vomica,  175.     Olive  oil  enemata,  188.     Castor  oil  and 


272  VAGINAL    TUMORS VAGINITIS. 

turpentine  enemata,  190. — Locally:  Cold  salt  water  hip  baths.  Alum 
and  zinc  injections, 425.  Tannin  and  catechu  pessaries,  423.  Boxwood, 
or  India-rubber  pessaries.  Diminution  of  vaginal  capacity,  by  dissecting 
off  one  or  more  strips  of  mucous  membrane,  and  bringing  edges  to- 
gether with  interrupted  suture. 

VAGINAL  TUMORS.— These  growths  may  consist  of: 

PoU/j/us  of  vfKjina.  Very  rare.  Produces  leueorrhoea,  bearing-down, 
irritability  of  bladder,  &c.  May  be  cured  by  excision.  If  any  vessel  be 
felt  pulsating  in  pedicle,  a  ligature  should  be  applied,  and  tumor  snipped 
off  just  below  it. 

Fibrous  tumors.  Sometimes  found  imbedded  in  submucous  tissue  of 
vaginal  wall.  Seldom  troublesome:  may  perhaps  cause  hemorrhage. 
Cxrowth  can  be  shelled  out  with  fingers  or  handle  of  scalpel,  after  divi- 
sion of  mucous  membrane  covering  it. 

Mucous  follicular  cysts.  May  be  superficial ;  formed  by  dilated  follicle, 
excretory  orifice  of  which  has  closed.  Deep-seated  cysts  produced  by 
accumulation  of  contents  of  interstitial  or  closed  follicles.  Either  form 
to  be  cured  by  puncture,  and  application  of  nitrate  of  silver  to  inner 
walls. 

VAGINISMUS. — From  Vagina,  a  sheath;  terminal  -ismns. — An  in- 
voluntaiy  spasmodic  closure  ot  the  sphincter  muscle  of  the  vagina,  with 
such  excessive  supersensitiveness  of  the  surrounding  tissues  as  to  form 
a  complete  barrier  to  coition  (Marion  Sims). 

May  exist  as  a  simple  or  complicated  state.  In  first  case,  no  local 
structural  change.  Excessive  tenderness  of  vaginal  orifice,  and  of 
hymen  or  its  remains.  Slightest  touch  causes  great  agony.  In  second 
form,  in  addition  to  supersensitiveness,  inflammation  of  follicles  about 
vulva;  or  fissure  of  fourchette ;  or  hypersesthesia  of  entire  vaginal  mu- 
cous lining;  or  some  uterine  displacement;  or  a  contracted  state  of  os 
uteri  and  cervical  canal.  In  either  form,  essential  remedy  consists  in 
removal  of  hymen,  incision  of  vaginal  orifice,  and  subsequent  dilatation 
with  graduated  bougies. 

VAGINITIS. — From  Vagina,  a  nhGnth;  terminal -^Yit'.s.  Inflammation 
of  the  vagina  may  be  acute  or  chronic  : 

1.  Acute  Vaginitis. — Synon.  Elytritis ;  Colpitis. — Not  very  common. 
Morl)id  action  not  always  limited  to  mucous  membrane:  tissues  beneath 
sometimes  involved,  causing  distressing  suffering.  Arises  from  violence  ; 
pressure  of  foetal  head  in  lingering  labor;  want  of  cleanliness  with  de- 
pression of  vital  powers,  etc. 

Symptoms.  Pain  and  sense  of  heat  in  vagina.  Itching  about  vulva. 
Irritability  of  bladder.  At  first,  mucous  inembrane  dry  and  swollen  : 
secretion  of  mucus  checked.  Then,  creamy  mucus,  or  muco-purulent 
matter,  or  pus  is  poured  out :  pain  diminishes.  Backache;  pains  about 
hips  and  upper  part  of  thighs  ;  sense  of  weight  or  bearing-dovvn  ;  smart- 
ing and  tenderness.  Disease  runs  its  course  in  seven  or  eight  days,  or 
subsides  into  chronic  form. — If  submucous  tissues  be  involved,  there 
may  be  rigors,  fever,  headache,  rapid  pulse,  severe  throbbing  pains. 
Suppuration  :  abscess  bursts  into  vagina,  or  pus  bui'rows  making  its  way 
to  perineum  or  sides  of  labia. 

Treatment.  Hot  hip  baths.  Vaginal  injections  of  warm  water. 
Pessaries  of  oxide  of  zinc  and  belladonna,  or  of  acetate  of  lead  and 
opium,  423.  Confinement  to  bed  or  sofa.  Castor  oil.  Cubebs.  Fish 
diet:  eggs,  milk,  tea,  demulcent   drinks. — If  supj>uration   occur:  Am- 


VARICELLA — VASCULAR   TUMORS    OF    URETHRAL    ORIFICE.  273 

mouia  and  bark,  371.  Quinine  Avith  mineral  acids,  379.  Opium  or 
morphia,  343.  Opium  and  belladonna,  344.  Fomentations  or  linseed 
poultices  to  vulva.     Abscesses  to  bo  ojjened  if  they  point. 

2.  Chronic  Vaginitis.  —  Synon.  Catarrhus  Genitalivm ;  Bleniwrrhoea 
Genitallum ;  The  Whites;  Vaginal  Leiicorrhoea  {AzuyMq^  Avhite;  pioj^  to 
flow). — One  of  the  most  common  diseases  to  which  women  (particularly 
the  married)  are  liable. 

Symptoms.  Constant  or  frequent  leucorrh(x?al  discharge  —  "the 
whites."  Backache;  sense  of  weariness  after  sligbt  exertion.  Loss  of 
ap])etite;  indigestion;  flatulence  and  constipation.  Mental  depression. 
— Exfoliation  of  epithelial  covering  of  mucous  membrane  may  occur: 
comes  away  in  flakes,  or  in  masses  forming  complete  casts  of  vagina. 

Treatment.  Mineral  acids  and  bark,  376.  Nitro-hydrochloric  acid, 
378.  Mineral  acids  and  quinine,  379.  Quinine  and  steel,  380.  Phos- 
phate of  iron,  405.  Gallic  acid.  Colchicum.  Cod-liver  oil.  Pepsine. — 
Cold  salt  water  hip  baths.  Astringent  injections,  425.  Tannic  acid,  or 
sulphate  of  zinc,  or  acetate  of  lead  pessaries,  423.  Brushing  vaginal 
walls  with  solution  of  nitrate  of  silver,  or  solution  of  carbolic  acid  in 
glycerine  (gr.  10  to  fl.  oz.  j). 

VARICELLA. — The  dim.  of  Variola  (  Varius,  spotted).  Synon.  Var- 
iola. Spuria;  FseudovarioUv. — The  mildest  of  the  eruptive  fevers.  Often 
classed  with  the  Vesicular  skin  diseases. — See  Chicken-pox. 

VARICOCELE. — From  Varix,  a  dilated  vein  ;  xrp.-q,  a  tumor.  Synon. 
Oscheocele  Varicosa ;  Spermatocele;  Oii'socele  (i'rom  Juptrd':,  a.  yarix;  xv^Xtj). 
— A  varicose  condition  of  the  veins  of  the  spei-matic  cord  may  arise 
from  any  cause  which  retards  upward  flow  of  blood,  —  as  tumors, 
trusses,  constipation,  corpulence,  frequent  straining  in  erect  posture, 
&c.  Spermatic  veins  on  left  side  most  frequently  afl^ected,  owing  to 
their  greater  length,  and  greater  liability  to  pressure  from  a  distended 
colon. 

Symptoms.  Swelling;  pyriform  with  base  on  testis.  Veins  can  be 
rolled  under  fingers,  like  worms  in  a  bag.  Weight,  and  aching  about 
groin  and  loin.  Uneasiness  or  pain  about  scrotum.  Neuralgia  of  test-, 
icle,  sometimes  atrophy.     Mental  depression. 

Treatment.  Palliative:  A  regular  action  of  bowels  to  be  insured  by 
attention  to  diet,  mild  apei'ients.  Improvement  of  general  health; 
mineral  acids,  nux  vomica,  &c.  Bathing  scrotum  with  salt  water  night 
and  morning.  Firm  support  with  a  suspensory  bandage.  Invagination 
of  loose  skin  of  scrotum  through  a  padded  steel  ring.  Radical  cure : 
Obliteration  of  the  veins.  To  be  accomplished  either  by  a  spring  truss, 
or  by  passing  ligatures  of  silver  or  iron  wire  subcutaneously,  so  as  only 
to  divide  the  veins,  or  by  passing  a  hare-lip  pin  underneath  the  veins, 
and  then  twisting  a  figure  of  8  suture  over  it.  !None  of  these  proceed- 
ings free  from  risk. 

VARIOLA. — From  Frtrfws,  spotted.  Synon.  Testis  Variolosa. — Avery 
contagious  eruptive  fever;  the  frequency  and  severity  of  which  have 
been  greatly  diminished  by  the  discover}^  of  vaccination.  Included  by 
Willan  in  the  Pustular  order  of  skin  diseases. — See  Small-pox. 

VASCULAR  TUMORS  OF  URETHRAL  ORIFICE.— Synon.  Urethral 
Hoimorrhoids. — Not  uncommon  in  females  :  very  rarely  vascular  tumors 
have  been  found  at  orifice  of  male  urethra. 

In  women,  external  orifice  of  meatus  urinarius  is  the  most  frequent 

18 


274  VENEREAL    DISEASE — VESICAL   INFLAMMATION. 

Beat  of  vascular  tumor.  Excrescence  varies  in  size  from  that  of  a  pin's 
head  to  that  of  a  date-stone.  Exquisitely  eensitive,  often  causing  ii-ri- 
tability  of  bladder  with  pain  on  passing  water.  To  be  cured  by  excision 
and  subsequent  application  of  actual  cautery  to  submucous  base.  Or  a 
ligature  may  he  applied,  passing  a  tenaculum  through  base  and  tying 
tightly  round  it.  Chloroform  usually  necessary  for  either  operation. 
Patient  to  be  in  position  for  lithotomy.  Acid  solution  of  nitrate  of  mer- 
cury, or  potassa  fusa,  sometimes  employed.  Nitrate  of  silver  worse 
than  useless. 

VENEREAL  DISEASE.— From  Venus,  the  Goddess  of  Love.  A  term 
generally  apj)lied  to  those  disorders  which  result  from  impure  connec- 
tion.— See  Gonorrhoea;  Syphilis,  &c. 

VERRUCffi.  —  From  Verriica,  a  wart.  Synon.  Ecthyma  Verruca; 
Vegetations;  Warts. — Consist  of  collections  of  hj^pertrophied  cutaneous 
papillse;  each  j)apilla  being  separate  and  merely  covered  with  thin 
cuticle,  or  a  bundle  of  papillfe  being  bound  together  by  an  excess  of  dry 
and  hard  scaly  epithelium. 

Treatment.  Excision.  Nitrate  of  silver.  Glacial  acetic  acid.  Acid 
solution  of  nitrate  of  mercury.  Creasote.  Carbolic  acid.  Savin.  Chromic 
acid,  196.     Tincture  of  jDerchloride  of  iron. 

VERTIGO. — From  Verio,  to  turn  round.  Synon.  Circnmgyratio ;  Gid- 
diness;  Swimming  of  the  Head. — A  transitory  sense  of  giddiness,  of  whirl- 
ing round,  or  of  falling.  Surrounding  objects  appear  to  be  in  motion  : 
sufferer  loses  his  balance  for  a  moment  or  two,  and  is  in  danger  of  fall- 
ing unless  he  can  grasp  some  object.  Usually  followed  by  headache : 
occasionally,  by  nausea. 

Often  a  symptom  of  incipient  disease  of  brain.  Sometimes  betokens 
general  weakness  ;  or  a  poison  in  blood,  as  opium  or  tobacco  or  alcohol ; 
or  some  cardiac,  hepatic,  renal,  gastric,  or  intestinal  affection.  Any 
disturbance  of  cerebral  circulation  will  induce  giddiness.  In  mild  form 
of  epilepsy,  giddiness  and  a  tit  of  absence  (epileptic  vertigo)  are  promi- 
nent symptoms.  Swimming  in  head,  a  forerunner  of  apoplexy  and  pa- 
ralj^sis.  Paroxysmal  attacks  not  uncommon  in  the  aged,  either  witliout 
..obvious  cause,  or  from  disease  of  coats  of  cerebral  arteries,  or  from  pas- 
isive  venous  congestion. 

Tonic  and  antispasmodic  remedies  more  frequently  called  for  than 
those  of  a  lowering  nature.  Chalybeates  when  there  is  anannia.  Pur- 
gatives, spare  diet,  blisters  behind  ears,  outdoor  exercise  if  there  be  evi- 
•dence  of  active  arterial  congestion.  Small  doses  of  corrosive  sublimate 
.in  simple  vertigo  of  old  people. 

VESICAL  INFLAMMATION.— From    Vesiea,  the  urinary  bladder: 

Tntiiimnio,{o'u\i\iimii.     Synon.  Cystitis;  Cystophlogia ;  Tnflanimatio  Vesicae. 
— Intiammation  of  the  bladder  may  be  acute  or  chronic: 

1.  Acute  Cystitis. — From  Ku^Tce;,  a  bladder;  terminal  -itis.  A  severe 
disease  wliicli  may  arise  idio])athically ;  or  may  supervene  on  chronic 
intiammation.  irritation  of  a  calculus,  external  injuiy,  disease  of  pelvic 
viscera,  &c.  Mucous  lining  of  neck  and  bas-fond  of  bladder  more  fre- 
.quently  attacked  than  all  tlie  coats. 

Symptoms.  Shivering.  Pain  over  bladder.  Heat  of  urethra:  con- 
stant desire  to  pass  urine,  which  comes  away  in  small  quantities.  High 
fever.  Nausea.  Constitutional  disturbance  :  mental  depression.  Blad- 
der can  perhaps  be  felt  as  a  small  rounded  tender  tumor.     Severe  pain, 


VESICAL    IRRITABILITY.  27o 

extending  to  perineum  and  down  thighs:  increased  by  abdominal  pres- 
sure, rectal  or  vaginal  examination.  Tenesmus. — Unless  resolution 
occur, — unbearable  ])ain.  Constant  calls  to  micturate:  urine  expelled 
ill  drops,  or  retention.  Urine  becomes  fetid  and  alkaline:  contains 
shreds  offibrine  entangling  pus  and  blood  cor])uscles.  Great  prosti'ution. 
Cold  clammy  sweats.     Low  muttering  cb'lii'ium.     Fatal  exhaustion. 

Trkatment.  Opium.  0})iuni  and  belladonna,  344.  Aconite.  Hot 
hip  baths.  Fomentations.  Linseed  or  hemlock  poultices.  Castor  oil. 
Mucilaginous  fluids.  Catheterism.  Wine,  bi'and}',  cream,  raw  eggs, 
essence  of  beef,  etc.,  as  soon  as  indications  of  exhaustion  couimence. 

2.  Chronic  Cystitis.  —  Sjnion.  Cystirrhcea ;  Cystorrhosa ;  Blennorrhoea 
ZJrinitlls;  Tenesmus  Vesicce  Mucosus ;  Catarrhus  Vesica;. — This  form  of 
inflammation  common.  Sometimes  follows  an  acute  attack :  more  fre- 
quently due  to  gout,  retention  of  decomposing  urine,  irritation  of  urine 
charged  with  saline  diuretics,  foreign  substances  in  bladder,  or  to  ex- 
tension of  inflammation  from  rectum  or  uterus,  &c. 

Symptoms.  Often  slight.  Feeling  of  indisposition.  Increased  sensi- 
bility of  bladder  walls.  Frequent  micturition.  Urine  scant}^  with 
perhaps  a  small  quantity  of  mucus  or  pus  :  sometimes  loaded  with  viscid 
ropy  mucus. 

Treatment.  Catheterism,  unless  bladder  can  be  thoroughly  emptied 
at  will.  Washing  out  bladder  with  warm  water;  or  with  solutions  of 
henbane,  opium,  or  some  astringent.  Opium  and  belladonna  sup- 
pository, 340.  Oxide  of  zinc  and  belladonna  vaginal  pessaries,  423. 
Belladonna  plaster  to  sacrum.  Benzoate  of  ammonia,  40.  Infusion  of 
bearberry  (infusum  uva?  ursi).  Infusion  of  buchu.  Decoction  ofpareii-a. 
Decoction  of  couch-grass.  Cubebs,  in  small  doses.  Demulcent  di'inks; 
barley-water,  infusion  of  linseed,  &c.  Animal  food:  milk  or  cream :  raw 
eggs.    Alcoholic  stimulants. 

VESICAL  IRRITABILITY.  —  From  Teska,  the  urinary  bladder. 
fijuoii.  Ijiijtatirittid  l\'sk'a' ;  Cysterethismns. — Irritability  of  the  bladder 
is  said  to  exist  when  there  is  an  unnaturally  frequent  desire  to  pass 
urine.  Ma}^  arise  from  organic  disease  of  kidneys,  bladder,  prostate 
gland,  or  urethra;  vascular  tumor  of  female  urethra;  pi'cssure  of  en- 
larged or  displaced  uterus;  irritation  of  haemorrhoids,  or  intestinal 
worms;  presence  of  a  tumor  or  calculus  in  bladder;  or  simply  from 
some  functional  derangement  of  kidneys,  bladder,  stomach,  or  nervous 
system. 

Symptoms.  Desire  to  micturate  comes  on  suddenly  and  frequently  : 
urine  may  have  to  be  passed  every  fifteen  or  thirty  minutes.  Inability 
to  resist  desire  :  if  attempted,  uneasiness  or  aching  pain.  Total  amount 
of  urine  seldom  increased  in  quantity.  Bladder  diminishes  in  size. 
General  health  suffers  from  the  annoying  irritation. 

Urine  always  to  be  examined.  If  preternaturally  acid  or  alkaline;  if 
loaded  with  urates,  phosphates,  or  oxalates;  or  if  it  contain  pus,  albu- 
men, sugar,  or  any  other  morbid  material, — disease  must  be  traced  to 
its  origin. 

Treatment.  Dilute  nitro-h^Hlrochloric  acid,  belladonna,  and  pareii-a, 
378.  Solution  of  potash  and  buchu,  69.  Ferruginous  tonics.  Decoction 
of  couch-grass  or  triticum  repens  (oz.  1  of  underground  stem  to  water 
fl.  oz.  xx).  Opiate  or  belladonna  suppositories,  340.  Oxide  of  zinc  and 
belladonna  pessaries  (for  women),  423.  Tincture  of  cantharides.  Tinc- 
ture of  benzoin.  Infusion  of  bearberry.  Colchicum.  Cod-liver  oil. — 
Warm  or  tepid  salt-water  baths.  Local  application  of  carbonic  acid 
gas.  Avoidance  of  stimulants.  Substitution  of  cocoa  for  tea  and  coffee. 
Mucilaginous  diluents. — See  Enuresis. 


276  VESICAL    PAKALYSIS — VESICAL    TUMORS. 

VESICAL  PARALYSIS.— From  Vesica,  the  urinary  bladder:  Tlapalmo^ 
to  affect  with  paralj'sis.  Synon.  Cy stop araly sis ;  Cystoplegia;  Acystin- 
ervia. — The  muscular  coat  of  bladder  may  become  paralyzed  from  some 
influence  confined  to  this  viscus;  disease  of  nervous  centres,  inducing 
simultaneous  loss  of  power  in  other  organs;  or  from  constitutional  de- 
bility. 

Symptoms.  Unlike  the  rectum,  the  bladder  retains  its  contents  when 
paralyzed.  When  distension  becomes  great,  urine  dribbles  away  by 
urethra :  hence,  incontinence  of  urine  often  an  indication  of  retention. 
Urine  loaded  with  mucus :  alkaline:  offensive  ammoniacal  odor.  Pain 
at  neck  of  bladder:  as  distension  gets  great,  the  walls  lose  their  sensi- 
bility. Severe  constitutional  disturbance.  Frequently,  death  from  coma 
or  exhaustion. 

Treatment.  Use  of  catheter:  bladder  to  be  slowly  but  thoroughly 
emptied.  Tejjid  or  cold  water  injections.  Ergot  of  rye.  Strychnia  or 
nux  vomica.  Ai-nica.  Aloetic  purgatives.  Hip  baths.  Galvanism, 
cold  douche,  or  blisters  to  lower  part  of  spine. 

When  disease  of  nervous  centres  exists,  symptoms  can  only  be  re- 
lieved as  they  arise. — See  Enuresis. 

VESICAL  SPASM.— From  Fes? ea,  the  urinary  bladder.  Synon.  Cysto- 
spasmus ;  Ischuria  iSpasmodica. — Spasmodic  attacks  of  pain  in  bladder. 
May  arise  from  vesical  calculus  or  tumor ;  diseases  of  rectum  and  uterus ; 
abscess  of  kidney;  ulceration  or  other  organic  disease  of  bladder,  pros- 
tate gland,  &c.;  abnormally  acid  urine;  excessive  venery;  hysteria;  or 
from  use  of  irritating  diuretics — cantharides,  oil  of  juniper,  savin. 

Symptoms.  Severe  pain  at  lower  part  of  abdomen,  extending  to 
urethra.  Involuntary  micturition  :  sometimes  retention  of  urine  with 
urgent  desire  to  micturate.  Tenesmus. — When  of  long  continuance, 
death  has  resulted  with  symptoms  of  suppression  of  urine. 

Treatment.  Relief  of  spasm  :  Hot  baths.  Hemlock  poultice.  Poppy- 
head  fomentations.  Linseed  poultice  with  camphor  to  perineum. 
Opium  and  belladonna  suppository,  340.  Ether  and  opium  draughts, 
85.     Mucilaginous  drinks. 

JRetnoval  of  cause :  Colchicum.  Quinine.  Citrate  of  jDotash.  Regula- 
tion of  diet:  avoidance  of  stimulants,  tea,  and  coffee.  Warm  clothing. 
Avoidance  of  violent  exercise  :  sexual  intercourse.  Appropriate  reme- 
dies for  renal  abscess,  calculi,  &c. 

VESICAL  TUMORS.— From  Vesica,  the  urinary  bladder.— The  growths 
which  may  be  developed  on  the  walls  of  the  bladder  are:  Warty  or 
polypoid  fibrous  bodies;  villous  or  vascular  growths;  and  malignant 
tumors. 

Symptoms.  Whatever  the  nature  of  the  tumor,  the  symptoms  resemble 
those  caused  b}^  a  calculus.  Frequent  micturition.  A  painful  sense  of 
inability  to  empty  bladder.  Urine  may  be  bloody,  or  purulent,  or  am- 
moniacal and  loaded  with  mucus. 

Malignant  more  common  than  innocent  growths.  Medullary  cancer, 
or  epithelioma,  more  frequent  than  scirrhus.  Cancerous  deposit  gener- 
ally primary  ;  but  may  result  from  extension  of  disease  from  rectum, 
pi'ostate,  uterus,  or  vagina.  Suffering  very  great.  Ui'ine  bloody:  per- 
haps cancer-cells  may  be  found. 

Treatment.  Relief  of  prominent  symptoms.  Narcotics,  to  ease  jjain. 
Asti-ingents,  to  check  hemorrhage.     Nutritious  food. 

Polypoid,  fibrous,  and  pendulous  villous  growths,  have  been  removed 
by  ligature  from  female  bladder,  owing  to  ease  with  which  urethra  can 
be  dilated. 


VILLOUS   CANCER — VOMITING   AND    RETCHING.  277 

VILLOUS  CANCER.— From  Villus,  shaggy  hair.— A  variety  of  medul- 
lary and  perhaps  of  epithelial  cancer,  occurring  most  frequently  on  mu- 
cous mcmhraue  of  urinary  bladder.  The  histories  coincide  with  those 
of  medullary  cancers. — See  Cancer. 

VITILIGO. — From  Vitulus,  a  calf;  terminal  -igo.  A  rare  disease,  said 
to  produce  a  glistening  veal-like  appearance  of  skin. — Two  varieties: 
Vltilujoidea  plana  and  V.  tuberosa,  which  may  occur  separately  or  com- 
bined. In  former,  irregular  yellow  patches  are  observed,  slightlv  ele- 
vated and  hard;  in  latter,  isolated  or  confluent  tubercles,  ranging' from 
the  size  of  a  pin's  head  to  that  of  a  large  pea.  Possibly  there  may  be 
some  connection  between  this  skin  disease  and  derangement  of  the  liver. 

Yitiligo  sometimes  confused  by  authors  with  lepral  alj)hoides,  or  with 
lupus  non-exedens.  Other  writers  seem  to  regard  the  appearances  as 
merely  due  to  a  diminution  of  pigment,  without  any  change  of  texture; 
making  it  of  same  nature  as  leucoderma.  Xo  remedy  for  it  at  present 
known. 

VOMITING  AND  RETCHING.— Synon.  Emesis;  Sickness  of  the  Stom- 
ach; Spewing. — Vomiting  (ti-om  Fowio)  is  due  to  forcible  and  repeated 
contractions  of  the  stomach,  with  relaxation  of  the  cardiac  sphincter,  so 
that  the  gastric  contents  are  expelled  upwards.  In  retching  there  are 
fruitless  attempts  to  empty  the  stomach,  the  cardiac  sphincter  being 
contracted;  or  the  stomach  is  empty. 

Sickness  arises  in  many  diseases:  i.  e.,  cerebral,  pulmonary,  renal,  bil- 
iary, gastric,  intestinal,  or  uterine  and  ovarian  disorders.  It  may  be 
due  to  symj)athetic  ii'ritation  of  pregnancy.  To  ingestion  of  poisonous 
or  irritating  substances  :  drunkenness.  To  blood-poisoning,  as  in  ichor- 
hffiinia ;  continued  and  eruptive  fevers.  Or  it  may  occur  as  an  idiopathic 
aftection, — no  other  morbid  state  being  discoverable. 

Symptoms.  Vary  with  the  cause.  Some  prominent  distinctions  are 
shown  in  following  table  : 

Gastric  or  Hepatic  Vomiting.  Cerebral  or  Sympathetic  Vomiting. 

1.  Nausea  relieved,  at  all  events,  tern-  1.  Little  or  no  nausea.  Ketching  con- 
porarily,  by  the  discharge  of  the  stom-  tinues,  often  in  spite  of  stomacli  being 
ach's  contents.  empty.     Directly    any    fluid   or    solid    is 

taiven,  it  is  rejected. 

2.  Vomit  consists  of  partially  digested  2.  Vomit  consists  of  unaltered  food.  Of 
food,  biliary  matters,  and  offensive  secre-  frothy  mucus.  Never  pus  or  blood, 
tions.    Sometimes  acid  water;  pus;  blood.  Sometimes  a  tinge  of  bile. 

3.  Loss  of  appetite,  or  even  a  disgust  3.  Appetite  remains.  Frequently  a  de- 
for  food.  sire  for  food  immediately  after  vomiting. 

4.  Tongue  coated;  breath  foul;  con-  4.  Tongue  clean;  breath  pure;  conjunc- 
junctivie  often  yellowish;  headache  sec-  ti vie  colorless,  or  only  injected;  headache 
ondary  in  point  of  time.  primary. 

5.  Griping  abdominal  pain  ;  fetid  eruc-  5.  No  eructations  of  foul  air.  Gener- 
tations ;  diarrhoea;  unhealthy  watery  ally,  obstinate  constipation;  or  stools 
stools.  solid  and  healthy. 

6.  Retching;  increased  salivation;  more  6.  Stomach  emptied  without  effort;  no 
or  less  abdominal  tenderness ;  faintness  or  increase  of  saliva;  no  abdominal  tender- 
exhaustion,  ness ;  little  or  no  fatigue  or  faintness  after 

vomiting. 

Treatment.  General  remedies:  Attention  to  diet:  bland  simple  nour- 
ishment, in  small  quantities  at  a  time.  Aperient  enemata,  188, 189,  190. 
Calomel  in  purgative  doses  (grs.  5  to  10).  Calomel,  blue  pill,  or  mer- 
cury with  chalk,  as  alteratives.  Taraxacum,  227,  228.  Seidlitz  powders, 
169.  Podophj'Uum,  160.  Carbonate  of  magnesia.  Tartaric  or  citric 
acid.  White  bismuth,  65.  Charcoal  biscuits.  Cotfee.  Carbonic  acid. 
Citrate  of  ammonia,  potash,  or  soda  in  effervescence,  348,  362,  403.    Di- 


278  VULVAL    CANCER — VULVAL   CORRODING   ULCER. 

lute  hyclrocj'anic  acid,  70,  86,  377.  Laurel  leaf  water  (aqua  laurocerasi, 
min.  X  to  xxx).  Dilute  nitro-hydrochloric  acid,  378.  Creasote,  41,  90. 
Carbolic  acid.  Eectified  pyroxylic  spirit  (spiritus  pyroxylicus  rectifi- 
catus,  min.  v  to  xl).  Carbonate  of  ammonia.  Aromatic  spirit  of  am- 
monia. Infusion  or  tincture  of  calumba.  Cinnamon.  Spirit  of  chloro- 
form. Three  or  four  drops  of  chloroform  on  a  lump  of  sugar.  Spirit 
of  ether.  Nitrate  of  silver.  Sulphate  of  copper.  Oxide  of  silver,  47. 
Salicin,  388.  Sulphite  of  soda,  48.  Opium.  Belladonna.  Pepsiue,  420. 
Ice. 

Locally :  Sinapisms  over  epia'astrium.  Blisters.  Seton.  Issues.  Hem- 
lock poultices.  Linseed  poultices.  Wet  compress,  136.  Belladonna, 
opium,  warm  galbanum.  pitch,  or  chalybeate  plaster.  Extracts  of  bel- 
ladonna and  poppies,  297.     Dr^"  cupping.     Leeches. 

ISympaihetic  vomiting,  in  pregnancy,  vterine  or  ovarian  disease,  rf-c. :  Ice 
to  suck  freely.  Soda  water.  Champagne;  sparkling  Hock  or  Moselle. 
Pepsine,  420.  Tincture  of  iodine  in  small  doses.  Strong  cotfee  before 
rising  in  the  morning.  Infusion  of  cloves.  Lemon-juice.  Oxalate  of 
cerium  (gr.  1  to  2  in  a  pill).  Rectified  pyroxylic  spirit.  "VYhite  bis- 
muth. Effervescing  draughts  with  calumba,  cascarilla,  &c.  Setons,  is- 
sues, sinapisms,  stimulating  liniments,  turpentine  stupes,  or  repeated 
flying  blisters  to  epigastrium.  Leeches  to  os  uteri,  if  there  be  conges- 
tion :  nitrate  of  silver,  if  there  be  excoriation  or  ulceration.  Yaginal 
pessaries  of  iodide  of  lead  and  belladonna,  423.  In  \qyj  severe  cases, 
the  induction  of  premature  labor. 

Hysterical  vomiting:  Sumbul,  369.  Nux  vomica,  or  strychnia,  387, 
407,  408.  Assafoetida,  89,  190.  Yalerian,  87,  303,  411.  Shower  baths. 
Dry  cupping  over  stomach  and  margins  of  lower  ribs. 

Sea-sickness:  Eecumbent  posture.  Ammonia.  Brandy.  Whiskey. 
Chloroform  by  inhalation,  or  a  few  drops  on  sugar.  A  tight  belt  round 
the  body.     Chapman's  ice  bags  to  spine. 

See  Gastritis;  Gastric  Ulcer;  Gastric  Cancer;  CJiolera ;  Hcematemesis ; 
Obstruction  of  Boicels,  &c. 

VULVAL  CANCER. — From  Vulva,  a  covering. — or  perhaps  as  if 
Valvce,  folding  doors. — Any  part  of  external  genitals,  or  of  vaginal 
walls,  may  become  the  seat  of  malignant  disease.  Occurs  primarily,  or 
secondarily.  Epithelial  cancer  more  common  than  other  forms.  Eelief 
may  be  given  by  excision,  where  disease  is  confined  to  external  labia. — 
See  Cancer. 

VULVAL  CORRODING  ULCER.— Synon.  Vulval  Esthiomenos  QEaOim, 
to  corroile  or  eat  away). — An  inveterate  and  progressive  ulceration  of 
external  genitals.     Probably  of  same  nature  as  Rodent  ulcer. 

Symptoms.  An  intractable  ulceration,  which  commences  on  some 
part  of  external  genitals,  and  gradually  creeps  over  vulvo-anal  region  : 
surrounding  structures  have  a  tendency  to  become  hypertrophied.  As 
ulcer  heals  in  one  direction,  it  extends  in  another:  process  of  repair  ac- 
companied by  formation  of  a  firm  burn-like  cicatrix,  which  has  a  ten- 
dency to  cause  contraction  of  vaginal  or  anal  orifice.  Suftering  very 
slight  for  several  months:  until  vaginal  orifice  becomes  fissured  by  it, 
or  mouth  of  urethra  gets  involved,  there  is  no  pain  during  sexual  inter- 
course or  micturition.  For  a  long  time,  general  health  not  affected; 
menstruation  occurs  regularl}'';  neither  loss  of  strength  nor  flesh.  But 
unless  a  cure  be  eftected,  profuse  discharge  ultimately  proves  very  weak- 
ening; appetite  fails;  dyspepsia;  attacks  of  colliquative  diarrhoea; 
sometimes,  hemorrhage. 

Death  seldom  occurs  until  after  lapse  of  eight  or  ten  years.     May  be 


VULVAL    PKURITUS — VULVAL   TUMORS.  279 

due  to  peritonitis;  erysipelas;  stricture  of  rectum;  hemorrhage;  or 
fatal  exhaustion. 

Treatment.  Thorough  excision;  with  extirpation  of  any  tubercular 
excrescences,  if  present.  Use  of  tents  or  bougies,  as  parts  heal,  to  pre- 
vent undue  contraction  of  vaginal  and  anal  orifices.  Efficacy  of  poten- 
tial caustics  very  doubtful.  Nourishing  food.  Cod-liver  oil.  Daily  hip 
baths.     Anodyne  lotions. 

If  there  be  any  suspicion  of  syphilitic  taint, — Iodide  of  potassium,  31. 
Green  iodide  of  mercury,  53.  Hed  iodide  of  mercury,  54.  Donovan's 
triple  solution,  51.     Mercurial  vapor  bath,  131. 

VULVAL  PRURITUS ,— From  Vulva,  a  covering:  Pn.irio,  to  itch.— 
Irritation  of  the  vulva  may  be  simply  a  local  affection  ;  or  a  symptom 
of  some  disease, — excoriatiou  of  labia  uteri,  onset  of  carcinoma,  &c. 
Not  uncommon  in  advanced  life :  sometimes  troublesome  during  preg- 
nancy. 

Symptoms.  Itching,  tingling,  formication,  or  smarting  about  vulva: 
increased  by  stimulants  and  warmth.  The  scratching  resorted  to,  pro- 
duces irritating  excoriations  and  scabs  about  vaginal  labia,  perineum, 
vestibule,  and  mons  Veneris.  The  constant  annoyance  causes  general 
irritability,  restlessness  at  night,  loss  of  a])petite,  &c. 

Pruritus  not  to  be  confounded  with  irritation  from  prurigo,  presence 
of  lice,  follicular  vaginitis,  eczema,  or  from  crops  of  small  boils. 

Treatment.  Generally:  Sulphate  of  soda  and  sulphur,  148.  Sulphur 
and  magnesia,  153.  Compound  powder  of  rhubarb.  Ehubarb  and  blue 
pill,  171.  Steel  and  sulphate  of  soda,  180,  181.  Pepsine,  420.  Nitro- 
hydrochloric  acid,  378.  Phosphoi-ic  acid  and  nux  vomica,  376.  Quinine, 
379.  Quinine  and  belladonna,  45.  Tar  capsules,  36.  Arsenic,  52.  Cor- 
rosive sublimate,  27.  Colchicum,  46.  Copaiba.  Camphor.  Tincture 
of  Indian  hemp. — Plain  animal  food,  milk,  eggs ;  avoidance  of  alcohol, 
tea,  coffee. 

Locally :  Tobacco  lotion,  265.  Lotion  of  acetate  of  lead  and  prussic 
acid,  263.  Lotion  of  morphia  and  solution  of  potash,  266.  Lotion  of 
borax,  morphia,  and  glj'cerine,  268.  Painting  vulva  with  mixture  of 
equal  parts  of  belladonna  and  aconite  and  chloroform  liniments.  Cod- 
liver  oil.  Olive  oil.  Nitrate  of  silver.  Lime  liniment.  Glj'cerine  and 
rose-water  (one  part  to  eight).  Calomel  ointment.  Equal  parts  of  red 
oxide  of  mercury  ointment  and  cod-liver  oil.  Carbonate  of  lead  oint- 
ment. Hi])  baths.  Vaginal  injections  of  plain  water;  or  of  solution  of 
lead  and  poppies,  425. 

If  there  be  excoriatiou  of  labia  uteri  it  must  be  healed.  In  carcinoma, 
relief  may  be  given  to  irritation  by  pessai'ies  containing  oxide  of  zinc 
and  belladonna,  423. 

VULVAL  TUMORS. — Prom  Vulva,  a  covering, — or  pei'haps  as  if 
Valvoi,  folding  doors. — Several  varieties  of  morbid  growths  are  met 
with  about  the  vaginal  labia: 

1.  Encysted  Tumors. — Have  their  origin  in  connective  tissue  of  vag- 
inal labia;  or  in  one  of  lobules  of  vulvo-vaginal  gland;  or  in  entire 
gland.     The  tumor  feels  firm  but  elastic. 

Symptoms.  When  about  size  of  walnut,  discomfort  on  walking.  Pain 
after  intercourse.  Irritability  of  bladder.  Tenderness  about  time  of 
catamenial  periods.  Inflammation  and  suppuration  of  cyst  walls  may 
occur,  converting  tumor  into  an  encysted  abscess. 

Treatment. — Simple  incision,  seldom  followed  b}'  permanent  cure. 
Excision  of  portion  of  cyst  wall.     Evacuation  of  contents,  afterwards 


280  VULVITIS. 

rubbing  cyst  walls  with  nitrate  of  silver,  or  iodine  liniment.  Introduc- 
tion of  seton  through  entire  swelling.  Cj'st  to  be  dissected  out.  Sen- 
sibility to  be  removed  by  ether  spray  (Eichardson). 

2.  Fibrous  Tumors,  &c. — Occasionally  developed  in  one  of  the  labia 
majora ;  more  rarely  about  perineum.  They  vary  in  size  from  that  of 
a  hazel-nut  to  that  of  an  orange. 

Fatty  tumors  sometimes  met  with  in  same  situations.  May  become 
pediculated. 

The  only  remedy  for  either  form  of  growth  is  excision.  Sensibility 
to  be  removed  by  ether  spray. 

3.  Warty  Growths. — Usually  scattered  about  labia,  nymphae,  vestibule, 
perineum,  and  around  anus:  sometimes  appear  in  large  clusters.  They 
give  rise  to  irritation,  and  oifensive  moisture. 

Eemoval  with  scissors  necessary.  Sensibilit}'  to  be  destroA^ed  with 
ether  spray.  Hemorrhage,  if  any,  requires  application  of  solution  of 
j^erchloride  of  iron.     Escharotics  painful  and  inefficient. 

4.  Hypertrophy  of  Labia. — May  occur  to  an  enormous  extent :  some- 
times constitutes  a  form  of  elephantiasis.  Enlargement  often  due  to 
syphilitic  taint. 

Treatment.  Eed  iodide  of  mercury,  54.  Mercurial  vapor  bath,  131. 
Iodide  of  potassium.  31.  Iodide  of  iron,  32.  Excision  seldom  success- 
ful without  constitutional  treatment. 

5.  Abscess  of  Labia. — May  arise  from  a  blow,  forcible  sexual  inter- 
course, irritation  of  gonorrhoeal  or  acrid  leucorrhoeal  discharges,  &c. 
Produces  throbbing  pain,  heat  and  swelling,  constitutional  disturbance. 

A  free  incision  will  be  needed.  Eest.  Ammonia  and  bark,  371.  Cod- 
liver  oil.     Animal  food. 

6.  Pudendal  Hsematocele. — Synon.  Labial  Thrombus;  Sanguineous 
Tumor  of  Vulva. — Extravasation  of  blood  into  areolar  tissue  of  one  of 
the  labia  majora,  nymph®,  or  vaginal  walls  may  occur  from  injury: 
from  rupture  of  a  vessel  during  parturition. 

Symptoms.  Considerable  elastic  swelling.  Pain.  Tumor  sometimes 
bursts:  if  small,  clot  msiy  be  absorbed. 

Treatment. — Puncture ;  followed  by  application  of  pads  and  a  T- 
bandage  to  prevent  further  hemorrhage.  Latter  may  also  be  prevented 
by  lint  saturated  with  solution  of  perchloride  of  iron. 

VULVITIS. — From  Vulva,  a  covering;  terminal  -itis.  Synon.  In- 
flammatio  Vulvae. — Several  forms  of  troublesome  inflammation  may 
attack  the  vulva  : 

1.  Simple  Vulvitis. — Not  very  uncommon  from  want  of  cleanliness, 
excessive  intercourse,  venereal  taint,  or  irritation  of  adjoining  struc- 
tures,— rectum  or  uterus. 

Symptoms.  Pain  and  tenderness. '  Swelling.  Mucous  discharge. 
Heat  or  scalding  during  micturition.  Aching  about  loins,  groins,  and 
thighs.     Constitutional  disturbance. 

Treatment.  Seidlitz  powders.  Effervescing  citrate  of  magnesia. 
Cold  hip  baths.     Alum  or  lead  lotions.     Avoidance  of  stimulants. 

2.  Gangrenous  Vulvitis. — Has  on  a  few  occasions  prevailed  as  an  epi- 
demic amongst  lying-in  women. 

Symptoms.  Commence  three  or  four  days  after  delivery  with  vomit- 
ing and  diarrhoea,  or  fever  and  abdominal  pains,  or  with  slight  hemor- 
rhage. Prostration,  anxiet}^.  (Edematous  redness  of  vulva.  Disease 
progressing,  pultaceous  plates  form  on  interior  of  vulva,  somewhat  like 


VULVITIS.  281 

diphtheritic  membranes.  Separation  of  phates  does  not  occur  iintil  end 
of  first  or  second  week  :  small  suppurating  wounds  left.  Disease  may 
extend  to  uterus,  causing  gangrene.     Peritonitis. 

Treatment.  Mineral  acids  and  bark,  876.  Quinine,  379.  Quinine  and 
steel,  380.  Opium.  Cod-liver  oil.  Essence  of  beef.  Milk,  cream,  raw 
eggs.  Brandy  or  port  wine.  Locally :  Fomentations.  Yeast  poultices. 
Application  of  strong  hydrochloric  acid. 

3.  Follicular  Inflammation  of  Vulva. — Synon.  Follicular  Vaginitis. — 
An  accunuilation  of  sebaceous  matter,  or  an  inflammation  of  the  seba- 
ceous follicles  scattered  over  mucous  membrane  of  vulva.  Both  sides 
of  vaginal  entrance  usually  affected;  with  tissues  within  nymphse  and 
at  base  of  clitoris. — Very  intractable.  Most  common  during  pregnancy 
and  about  change  of  life. 

Symptoms.  Parts  found  moi-e  or  less  inflamed  :  studded  with  numer- 
ous raised  vascular  points,  sometimes  having  specks  of  ulceration  on 
summits.  Soon,  the  points  coalesce,  forming  a  strip  of  highly  injected 
mucous  membrane  :  subsequently  vascularity  disappears,  tissues  looking 
as  if  covered  with  white  paint  (Oldham).  Disturbance  of  general  health. 
Constriction  of  sphincter  vagina?  muscle.  Leucorrhoea:  irritation  and 
smarting  of  genitals.  Sexual  intercourse  very  painful.  Pains  in  back 
and  thighs. 

Treatment.  Locally:  Avoidance  ofcaustics  and  astringents.  Morphia 
and  hydrocyanic  acid  lotion,  26G.  Tobacco  lotion,  265.  Glycerine  and 
lime-water,  286.  Lime  liniment.  Iodide  of  lead  and  belladonna  oint- 
ment, 293.  Aconitine  and  calomel  ointment,  296.  Hydrocj^anic  acid 
and  atropia  ointment,  306.  Hemlock  poultices.  Warm  hip  baths,  con- 
taining extract  of  poppies  and  soda. 

Generally:  Plain  nourishing  food.  Avoidance  of  seasoned  dishes: 
tea,  coffee,  wine,  and  beer.  Milk.  Brandy  and  soda  water.  Arsenic 
and  bark,  52.  Mineral  acids  and  bark,  376.  Xitro-hydrochloric  acid, 
378.  Quinine  with  aconite,  379.  Corrosive  sublimate  and  sarsaparilla, 
27.     Cod-liver  oil.     Change  of  air. 

4.  Pudendal  Erythema. — Generally  from  want  of  cleanliness,  or  from 
excessive  exhalation  of  moisture  in  stout  middle-aged  women,  the  sur- 
faces of  the  labia  and  perineum  and  upper  part  of  inside  of  thighs  be- 
come the  seat  of  an  erythematous  eruption.  Parts  of  a  bright  red  color  : 
sensation  of  heat  and  great  discomfort.  Severe  forms  may  end  in  ery- 
sipelas. 

Treatment.  Non-stimulating  diet.  Eemoval  of  any  derangement  of 
general  health.  Great  attention  to  cleanliness-.  Bathing  Avith  dilute 
solution  of  subacetate  of  lead.  Dusting  with  oxide  of  zinc,  or  powdered 
spermaceti.     Fuller's  earth,  a  common  domestic  remedy. 

5.  Infantile  Leucorrhoea. — An  irritation  or  subacute  inflammation  of 
mucous  glands  of  vulva,  producing  a  muco-purulent  or  purulent  dis- 
charge.— May  occur  from  irritation  of  worms  or  teething :  sometimes 
as  a  complication  during  progress  of  one  of  eruptive  fevers. 

Symptoms.  Derangement  of  general  health  :  children  often  strumous, 
badly  fed,  &c.  There  may  be  only  a  mucous  discharge,  with  irritation 
of  surrounding  parts:  if  disease  extend  up  vagina,  j^rofuse  purulent  dis- 
charge, heat  and  pain  during  micturition,  excoriation  of  surrounding 
parts,  perhaps  aphthous  ulceration.  Caution  necessary,  lest  disease  be 
wrongly  attributed  to  gonorrheal  infection,  or  to  violence  in  attempt- 
ing a  rape. — Fatal  sloughing,  or  gangrenous  ulceration  of  vulva,  very 
rare. — In  diphtheritic  vulvitis,  tough  false  membranes  formed  on  inner 
surface  of  labia.     Effects  of  diphtheritic  poison  very  seldom  confined  to 


282  WASTING   PALSY — YELLOW   FEVER. 

vulva. — Scarlatinal  vaginitis,  attended  with  exfoliation  of  patches  of 
epithelium. 

Treatment.  Plain  nourishing  food  :  milk.  Bai'k.  Quinine  and  steel. 
Cod-liver  oil.  Glycerine.  Chemical  food,  405.  Chlorate  of  potash. 
Warm  hip  baths.  Fomentations.  Alum  or  subacetate  of  lead  lotions. 
Sea  bathing. 

WASTING  PALSY. — A  degeneration  of  the  voluntary  muscles,  pro- 
ducing complete  loss  of  power. — See  Paralysis. 

WEIGHT  OF  BODY.— The  following  table  shows  the  normal  weight 
in  })roportion  to  height.  Loss  of  weight  an  early  symptom  in  phthisis. 
A  slow  and  gradual  fall,  more  serious  than  a  rapid  and  iiTegular  diminu- 
tion :  a  steady  loss  always  precedes  tuberculosis  (I)r.  Hutchinson)  : 


Weight  increased  I 

Exact  Stature. 

Mean  Weight. 

7  per  cent. 

Ft.'  in. 

St. 

lbs. 

lbs. 

St.   lbs.        lbs. 

5     1... 

.     .     .     8 

8  or 

120  .     .     . 

.     .     .     9     2  or  128 

5     2... 

.     .     .     9 

0   " 

126  .     .     . 

...99"    135 

5     3... 

.     .     .     9 

7   " 

133  .     .     . 

...   10     2   "    142 

5     4... 

.     .     .     9 

13   " 

139  .     .     . 

.     .     .  10     9    "    149 

5     5... 

.     .     .  10 

2   " 

142  .     .     . 

,     .     .  10  12   "    152 

5     6... 

.     .     .  10 

5   " 

145  .     .     . 

.     .     .11     1   "    155 

5     7... 

.     .     .  10 

8  " 

148  .     .     . 

.     .     .11     4   "    158 

5     8.     .     . 

.     .     .  11 

1    " 

155  .     .     . 

.     .     .  11  12   "    166 

5     9... 

.     .     .  11 

8   " 

162  .     .     . 

.     .     .12     5   "    173 

5  10  .     .     . 

.     ,     .  12 

1   " 

169  .     .     . 

...   12  13   "    181 

5  11  .     .     . 

.     .     .  12 

6   " 

174  .     .     . 

...  13     4   "    186 

6     0... 

.     .     .  12 

10  " 

178  .     .     . 

.     .     .18     8  "    190 

This  reads:  A  man  of  5  ft.  8  in.  should  weigh,  in  his  clothes,  11  st. 
1  lb.  or  155  lb.  (14  lb.==  1  stone);  he  may  exceed  this  by  7  per  cent., 
and  so  attain  11  st.  12  lb.,  or  166  lb.,  without  affecting  his  vital  capacity  ; 
beyond  this  amount  his  respiration  becomes  diminished.  According  to 
M.  Quetelet  the  average  weight  of  the  clothes  at  different  ages  is  one- 
eighteenth  of  the  total  weight  of  male  body,  and  one-twenty-fourth  of 
that  of  female. 

WRY-NECK. — Synon.  Torticollis. — A  distortion,  in  which  the  head  is 
drawn  down  to  one  side  (often  the  right),  and  the  face  directed  to  the 
opposite.  Due  to  contraction  of  one  sterno-mastoid  muscle.  Paralysis 
of  one  muscle,  allows  the  other  to  overpower  its  fellow.  Inflammation, 
or  rheumatic  spasm  of  one  muscle  ma}"  cause  it  to  conti'act  unduly. 
Sometimes  the  affection  is  owing  to  lateral  curvature  of  spine  ;  to  caines 
of  cervical  vertebric;  to  tumors  and  enlargement  of  cervical- glands  on 
one  side;  or  to  contraction  of  cicatrix  left  by  a  burn  or  ulcer. 

Treatment.  Injiammatory  or  rheumatic  variety:  Eest.  Fomentations 
or  hot  bathing.  Turkish  bath.  Ammonia  and  bark.  Aconite  or  bel- 
ladonna. Iodide  of  potassium  with  tincture  of  aotea  racemosa.  Fer- 
manentform:  Apparatus  to  produce  and  maintain  extension.  Division 
of  cicatrix,  if  present.  Subcutaneous  division  of  sternal  or  clavicular 
attachments  of  muscle,  or  of  both. — Paralytic  variety:  Friction,  blisters, 
irritating  liniments,  or  galvanism  to  palsied  muscle.  Tenotomy  on 
sound  side  sometimes  recommended.    Improvement  of  general  health. 

YELLOW  FEVER. — Synon.  Pestilentia  Hamiagastrica;  Bulani  Fever ; 
3!  a  I  de  Siam;  TyjiliHS  Icterodes;  Bilious  Remitting  Yelloio  Fever;  Black 
Vomit ;  Yelloio  Jack. — An  acute  and  very  dangerous  fever;  accom])anied 
with  jaundice,  severe  headache,  and  vomiting  of  black  matter.     Almost 


YELLOW   FEVER.  283 

limited  to  warm  climates.  Not  of  nnfrequent  occurrence  in  sea-port 
towns  of  tiie  West  Indies,  Africa,  southern  parts  of  Spain.  May  occur 
sporadically  or  epidemically.  Probably  infectious.  Male  sex  much 
more  obnoxious  to  the  morbid  poison  than  the  female. 

Symptoms.  Often  commence  suddenly  with  languor,  loss  of  appetite, 
giddiness,  headache,  mental  depression.  Sometimes  begin  with  cold-* 
ness  of  the  surface,  or  distinct  rigors;  followed  by  fever  which  con- 
tinues for  a  few  houi'S.  In  a  third  class  of  cases,  there  is  prostration 
from  the  first,  without  febrile  reaction  ;  stupor,  coma,  and  convulsions 
soon  following.  When  there  is  decided  fever,  it  generally  becomes 
aggravated  towards  night:  pulse  gets  quick,  skin  hot  and  dry,  eyes 
congested  and  painful,  face  flushed.  Distressing  headache;  perhaps 
confined  to  one  temple.  Pains  in  back  and  limbs;  in  large  joints.  Irri- 
tability of  stomach;  tenderness  on  pressure;  sense  of  tightness  about 
pnccordia;  nausea,  followed  after  a  few  hours  by  constant  vomiting 
and  retching.  Thirst,  with  desire  for  cold  drinks.  Urine  diminished 
in  quantity;  of  a  dark-red  color.  Constipation;  stools  free  from  bile. 
Distressing  restlessness;  mental  anxiety;  sleeplessness;  perhaps,  active 
delirium. — At  the  end  of  second  or  third  day,  sevci'ity  of  symptoms 
greatly  diminishes  :  patient  feels  much  relieved  :  face  gets  slightly  jaun- 
diced :  skin  becomes  moist,  and  there  are  copious  bilious  stools.  In 
favorable  cases,  convalescence  firmly  established.  More  frequently, 
improvement  of  short  duration.  After  some  twenty-four  hours,  epigas- 
tric tenderness  is  aggravated  :  jaundice  increases  and  spreads  over 
body :  tendency  to  stupor :  pulse  becomes  feeble,  irregular,  and  slow — 
perhaps  as  low  as  thirty  beats  in  the  minute  :  tongue  gets  foul  and  dry: 
respiration  embarrassed :  hiccough,  thirst,  nausea,  vomiting,  &c.,  are 
constant.  Unless  symptoms  remit,  grumous  blood  is  vomited — black 
vomit:  urine  is  suppi-essed  or  simply  retained  :  skin  becomes  of  a  dark- 
brown  hue:  dark-colored  blood  effused  in  patches  under  skin,  or  exudes 
from  nose,  gums,  anus,  vagina,  &c. :  most  offensive  tarry-looking  stools. 
There  are  now  all  the  features  of  a  most  malignant  fever:  almost  im- 
perceptible pulse;  slow  or  stertorous  breathing;  involuntary  evacua- 
tions ;  difficulty  of  deglutition  and  articulation  ;  suppressed  or  bloody 
ui'ine  ;  with  formation  of  buboes  or  patches  of  gangrene.  Death  takes 
place,  preceded  by  coma  or  convulsions;  or  patient  retains  consciousness 
to  the  close. 

Usual  duration  from  three  to  nine  days.  Mortality  about  one  in 
three.  Death  from  over])Owering  effect  of  poison  on  the  system,  ex- 
haustion, uraemia,  or  apoplexy. 

Treatment.  Prophylactic:  Eemoval  of  all  nuisances :  thorough  ven- 
tilation and  fumigation  of  narrow  courts,  cellars,  docks,  holds  of  ships, 
t\:c.  Cleanliness  on  board  ship :  pumping  out  of  foul  bilge-water. — In- 
dividuals exposed  to  risk,  to  live  on  plain  nourishing  food,  avoiding  the 
abuse  of  alcoholic  drinks  and  sexual  excesses :  to  have  a  due  amount  of 
sleep:  to  promote  healthy  action  of  skin,  kidneys,  intestinal  canal:  to 
have  Avarm  clothing:  not  to  venture  out  early  in  the  morning  with  the 
stomach  empty.  The  special  efficacy  of  strong  coffee,  quinine,  and 
inunction  with  lard  or  oil,  doubtful. 

Curative:  From  the  commencement  until  convalescence  is  firmly  es- 
tablished the  recumbent  posture  to  be  strictly  maintained :  bed  to  be 
placed  in  centre  of  well-ventilated  room:  great  attention  to  be  paid  to 
cleanliness.  The  indications  presented  by  the  urgent  sj^mptoms  to  bo 
observed.  The  disease  cannot  be  cured,  but  the  patient  may  be  guided 
through  it.  Simple  diet, — Arrowroot,  barley-water,  ice  and  iced  water, 
tea,  lemonade,  broth,  champagne,  spruce,  seltzer  water,  brandy  and 


284  ZONA. 

water.  Podophyllum.  Sulphate  of  mag-nesia  and  senna.  Calomel  with 
quinine,  or  jalap.  Quinine.  Bark.  Sulphate  of  beheria.  Tincture  of 
perehloride  of  iron.  Nitro-hydrochloric  acid.  Morphia,  in  a  small  dose. 
Turpentine.     Creasote.     Liquor  potassffi. 

Blisters  or  sinapisms  to  nucha.  Cold  to  the  head.  Compression  of 
the  temporal  arteries,  for  relief  of  cephalalgia.  Prolonged  use  of  warm 
bath,  or  of  wet  sheet.  Sinapisms  or  tuqjentiue  stupes  to  epigastrium. 
Venesection  :  if  at  all,  only  in  early  stage. 

Avoidance  of  ammonia ;  the  blood  often  strongly  ammoniacal.  Alco- 
holic stimulants  to  be  used  cautiously,  when  kidneys  are  much  congested. 

ZONA. — From  Zotia,  a  belt.  Synon.  Herpes  Zoster;  Shingles. — That 
form  of  herpes  in  which  the  vesicles,  with  their  inflamed  patches,  are 
arranged  in  the  form  of  a  band  encircling  half  the  circumference  of  the 
body. — See  Herpes. 


APPENDIX    OF    FORMULAE. 


APPENDIX  OF  FORMULAE. 


In  prescribing  a  medicine,  attention  must  be  paid  to  the  following  points:  Age, 
Sex,  Temperament,  Habit,  Condition  of  System,  Climate,  and  Season  of  tlie  Year. 
The  operation  of  most  drugs  is  materially  influenced  by  the  form  in  which  the  medi- 
cine is  given,  the  purity  of  the  preparation,  tlie  time  of  day  at  which  the  dose  is  taken, 
and  the  condition  of  the  stomach  as  regards  the  presence  or  absence  of  food.  The 
succeeding  formula  are  for  Adults,  unless  the  contrary  is  stated.  The  doses  may, 
except  in  the  case  of  mercurials  and  narcotics,  be  reduced  by  attention  to  this  table  : 

For  an  adult,  suppose  the  dose  to  be      ....  1  or  gr.  60. 

Under  1  year,  will  require  only l-12th  or  gr.     5. 

"       2  years,  "  l-8th    or  gr.     7^. 

"       3      "  <'  1-nth    or  gr.  10. 

"       4      "  "  l-4th    or  gr.  15. 

"       7      "  "  l-;]d     or  gr.  20. 

"     14      "  "  1-half  or  gr.  30. 

"     20      "  "  2-3ds    or  gr.  40. 

Above  21,  the  full  dose. 

"     65,  the  dose  must  be  diminished  in  the  inverse  gradation  of  the  above. 

Children  bear  as  large  doses  of  mercui'y  as  adults;  but  they  are  much  more  sus- 
ce]itible  to  the  influence  of  opiates.  Consequently,  opium  must  be  given  in  very 
minute  doses  to  them.  Females,  also,  from  their  jiiore  delicate  organization  and 
greater  sensitiveness,  require  smaller  quantities  of  powerful  medicines  than  males. 
This  is  particularly  the  case  during  the  periods  of  menstruation,  pregnancy,  and  lac- 
tation. 

The  skill  of  the  physician  is  shown  by  the  administration  of  the  proper  remedy,  in 
the  proper  quantity,  at  the  proper  time.  A  druggist's  apprentice  can  tell"  what  agents 
will  purge,  vomit,  or  sweat;  but  a  man  must  be  practically  conversant  with  disease 
to  be  able  rightly  to  apply  his  therapeutical  resources  to  the  exigencies  of  any  partic- 
ular case.  Instead  of  introducing  medicines  into  the  system  by  the  stomach,  it  is 
often  more  advisable  to  do  so  by  the  rectum,  or  by  the  skin,  or  by  the  lungs,  or  by 
injection  into  the  areolar  tissue.  Absorption  takes  place  from  the  rectum  as  sj)eedily 
and  surely  as  from  the  stomach  ;  and  hence  purgatives,  emetics,  narcotics,  tonics,  and 
nutrients  may  be  admirably  administered  as  enemata.  The  skin  offers  a  mechanical 
impediment  to  absorption  ;  but  still  poultices  and  fomentations,  plasters,  liniments 
and  ointments,  and  medicated  vapor  or  water  baths  are  all  valuable  remedies.  If  the 
cuticle  be  removed  by  a  blister,  and  the  medicine  applied  to  the  denuded  dermis  in  its 
pure  state,  or  incorporated  with  lard  or  mucilage,  its  action  will  be  rajiid.  The  sys- 
tem is  quickly  and  thorouglily  affected  by  tlu;  inhalation  of  medicatt'd  vapors,  or  of 
substances  reduced  to  an  impalpable  powder.  Subcutaneous  injections  must  be  em- 
ployed with  great  caution  ;  since  by  this  plan  none  of  the  medicine  is  lost,  neither  is 
it  altered  or  diluted  by  the  contents  of  the  stomach,  «s  happens  when  drugs  are  taken 
by  the  mouth. — In  only  exceptional  cases  can  there  be  any  advantage  in  procuring 
absorption  through  the  conjunctiva,  the  nasal  or  pituitary  membrane,  or  the  mucous 
coat  of  the  vagina;  but  in  these  exceptional  cases  the  benefit  is  often  very  great. — 
Injection  into  the  veins  is  too  dangerous  to  allow  of  its  being  practised  except  as  a 
last  resource  in  grave  diseases, — such  as  epidemic  cholera,  «&c. 

The  practitioner  will  do  well  to  bear  in  mind  the  following  rules:  1.  When  a  dis- 
ease is  progressing  favorably  towards  reco\ery,  it  is  unwise  to  interfere  with  the 
efforts  of  Nature  by  the  administration  of  drugs.  The  end  and  aim  of  treatment  is 
not  only  to  restore  health,  but  to  do  so  safely,  speedily,  and  pleasantly. — 2.  Where 
drugs  are  needed,  and  there  is  a  choice  of  remedies,  emphjy  that  one  which  will  be 
the  least  distressing  at  the  time,  and  subsequently  the  least  injurious  to  the  constitu- 


288  APPENDIX    OF   FORMULA. 

tion. — 3.  Put  the  medicine  in  that  form  in  which  it  can  be  most  easily  taken.  "When 
possible — especially  with  children — cover  the  disagreeable  taste  of  the  draught  by 
syrups,  &c. — 4.  If  there  be  an  idiosyncrasy  with  respect  to  any  special  medicine^ — 
such  as  mercury,  opium,  turpentine,  &c. — avoid  administering  it.  That  a  peculiarity 
of  constitution,  causing  an  extreme  susceptibility  to  the  influence  of  certain  drugs, 
food,  and  odors  sometimes  exists,  cannot  be  disputed.  It  is  as  certain  that  it  can  sel- 
dom be  safely  combated. — 5.  Attend  to  the  condition  under  which  the  patient  will  be 
at  the  period  of  the  medicine's  action;  e.g.,  it  will  be  worse  than  useless  to  give  a 
sudorific  to  an  individual  obliged  to  be  in  the  open  air  soon  after  taking  it. — 6.  Be 
careful  that  the  various  agents  in  the  prescription  are  not  incompatible  with  each 
other,  unless  it  be  desired  to  form  some  new  or  particular  compound.  Chemical 
incompatibility,  however,  is  by  no  means  synonymous  with  therapeutic  inertness  ;  for 
experience  tells  us  that  certain  unchemical  compounds — bichloride  of  mercury  and 
tincture  of  bark,  gallic  acid  and  tincture  of  opium,  calomel  and  Dover's  powder,  &c., 
are  all  valuable  preparations  in  curing  diseases. — 7.  Remember  that  if  a  disease  be 
incurable,  it  may  still  admit  of  great  alleviation.  Hence  it  is  cruel  to  give  up  any 
case  ;  although,  at  the  same  time,  the  patient  is  not  to  be  deceived  by  false  promises. — 
8.  Never  order,  or  sanction  the  use  of,  a  quack  medicine;  i.e.,  one,  the  composition 
of  which  is  kept  a  secret. — 9.  Bearing  in  mind  the  weakness  of  human  nature,  and 
the  prejudices  and  superstitions  which  are  current,  it  is  not  only  necessary  to  give 
good  advice,  but  pains  must  be  taken  so  to  impress  the  patient  and  attendants  that  the 
necessary  treatment  may  be  thoroughly  carried  out.  /fope  and  confidence  are  no  mean 
remedial  agents  ;  and  in  many  chronic  diseases  at  least,  the  individual  who  has  faith 
will  recover  more  speedily,  ceteris  paribus,  than  he  who  is  shy  of  belief. — 10.  Simply 
to  prescribe  drugs,  without  regulating  the  diet  and  general  management  of  the  pa- 
tient, is  to  omit  a  most  important  duty.  In  acute  diseases  plain  directions  must  be 
given  as  to  the  ventilation  and  warmth  of  the  sick-room,  the  amount  of  light,  the 
position  of  the  bed  (not  to  be  placed  in  a  corner),  the  degree  of  quiet  to  be  maintained, 
the  cleanliness  of  the  sufferer,  and  the  nature  and  quantity  and  times  for  administra- 
tion of  food.  In  cases  of  long  illness,  when  the  patient  can  be  moved  without  risk, 
it  is  often  desirable  to  have  two  beds  in  the  room, — one  to  be  occupied  during  the 
day,  the  other  at  night.  Every  precaution  must  be  taken  to  prevent  the  spread  of 
infectious  disorders.  And,  in  all  instances,  the  evacuations  ought  to  be  passed  in  a  bed- 
jian  or  night-stool  containing  some  disinfectant  fluid. — 11.  While  it  is  allowed  that 
the  folftwing  formulae  may  often  be  employed  unaltered  with  great  advantage,  j-et  it 
is  not  supposed  that  they  will  usually  be  prescribed  with  servile  exactness  ;  for  it  must 
never  be  forgotten  that  all  medicines  of  any  power  have  to  be  adapted  to  the  require- 
ments of  the  special  case  under  treatment.  It  has  been  quaintly  but  truly  observed, 
that  a  bundle  of  ready-made  receipts  in  the  hands  of  the  routine  practitioner,  is  but  a 
well-equipped  quiver  on  the  back  of  an  unskilful  archer. — And  12.  In  watching  the 
restoration  of  a  sick  man  to  health,  do  not  attribute  the  improvement  too  confidently 
to  the  action  of  the  medicine  prescribed  ;  for  it  may  not  have  been  taken,  or  it  may 
not  have  been  absorbed,  or  its  properties  may  have  been  destroyed  by  adulteration, 
or  it  may  have  even  proved  injurious — recovery  occurring  in  spite  of  it. 

The  succeeding  formulas  liave  been  written  in  accordance  with  the  rules,  prepara- 
tions, &c.,  of  the  British  Pharmacopoeia.  For  the  sake  of  convenience  they  are 
arranged  in  twenty  classes. — See  For-mulce  in  Tabular  Synopsis. 


ALIMENTS.  289 

I.  ALIMENTS. 

Formula  1.  Extract  of  Beef. 

'  Take  one  pound  of  rumpstoak,  mince  it  like  sausage-meat,  and  mix  it  with  one 
pint  of  cold  water.  Place;  it  in  a  pot  at  the  side  of  the  fire,  to  heat  very  slowly.  It 
may  stand  two  or  three  lunirs  before  il  is  allowed  to  simmer,  and  then  let  it  l)oil  gently 
for  fifteen  minutes.  Skim  and  serve.  The  addition  of  a  small  tablespoonful  of  cream 
to  a  teacupful  of  tiiis  beef  tea  renders  it  rielier  but  more;  nourishing.  Sometimes  it 
is  preferred  when  thickened  with  a  little  flour  or  arrowroot. 

2.  Restorative  Soup  for  Invalids. 

Take  1  lb.  of  newly  killed  beef  or  fowl,  chop  it  fine,  add  eight  fluid  ounces  of  soft 
or  distilled  water,  four  or  six  drops  of  pure  hydrochloric  acid,  M)  to  WO  grs.  of  common 
salt,  and  stir  well  together.  After  three  hours  the  whole  is  to  be  thrown  on  a  conical 
hair  sieve,  and  the  fluid  allowed  to  pass  through  with  slight  pressure.  On  the  flesh 
residue  in  the  sieve  pour  slowly  two  ounces  of  distilled  water,  and  let  it  run  through 
wliile  squeez;ing  the  meat.  There  will  be  thus  obtained  about  ten  fluid  ounces  of  cold 
juice  (cold  extract  of  flesh),  of  a  red  color,  and  possessing  a  jjleasant  taste  of  soup; 
of  which  a  wineglassful  may  be  taken  at  pleasure.  It  must  not  be  warmed  (at  least, 
not  to  a  greater  extent  than  can  be  ettected  by  partially  filling  a  bottle  with  it,  and 
standing  this  in  hot  water);  since  it  is  rendei'cd  mudd}'  by  heat  or  by  alcohol,  and 
deposits  a  tliick  coagulum  of  albumen  with  the  coloring  matter  of  blood. — If,  from 
any  special  circumstance  (such  as  a  free  secretion  of  gastric  juice)  it  is  deemed  unde- 
sirable to  administer  an  acid,  the  soup  may  be  well  prepared  by  merely  soaking  the 
minced  meat  in  plain  distilled  water. — Children  will  frequently  take  the  raw  meat 
simply  minced,  when  they  are  sufl'ering  from  great  debility.  One  teaspoonful  of  such 
meat  may  be  given  every  three  or  four  hours. 

This  modification  of  Liebig's  formula  is  very  valuable  in  cases  of  continued  fever, 
in  dysentery,  and  indeed  in  all  diseases  attended  with  great  prostration  and  weakness 
of  the  digestive  organs.  When  the  flavor  is  thought  disagreeable,  it  may  be  concealed 
by  the  addition  of  spice,  or  of  a  wineglassful  of  claret  to  each  teacupful  of  soup. 

3.  Essence  of  Beef 

Take  one  pound  of  gravy-beef,  free  from  skin  and  fat,  chop  it  up  as  fine  as  mince- 
meat, and  pound  it  in  a  mortar  with  two  tablespoonfuls  of  soft  water.  Then  put  it 
into  a  covered  earthen  jar  with  a  little  salt,  cementing  the  edges  of  the  cover  with 
pudding  paste.  Place  the  jar  in  an  oven,  or  tie  it  tightly  in  a  cloth  and  plunge  it  into 
a  j)ot  of  boiling  water  for  three  hours.  Strain  ott"  (through  a  coarse  sieve,  so  as  to  allow 
the  smaller  particles  of  meat  to  pass)  the  liquid  essence,  which  will  amount  to  about 
two  ounces  in  quantity.     Give  two  or  more  teaspoonfuls  frequently. 

In  great  debility,  diphtheria,  exhaustion  from  hemorrhage,  &c. 

4.  Liebig's  Food  for  Infants  and  Invalids. 

Half  an  ounce  of  wheaten  flour  (that  called  "seconds"  is  the  most  suitable),  an 
equal  quantity  of  malt  flour,  7|  grains  of  bicarbonate  of  potash,  and  an  ounce  of 
water,  are  to  bo  well  mixed.  Add  five  ounces  of  cow's  milk,  and  \nit  the  whole  on  a 
gentle  fire.  When  the  mixture  begins  to  thicken  it  is  to  be  removed  from  the  fire, 
stirred  for  five  minutes,  heated  and  stirred  again  till  it  becomes  quite  fluid,  and  finally 
made  to  boil.  After  separating  the  bran  by  passing  the  mixture  through  a  sieve,  it 
is  ready  for  use. 

To  save  the  trouble  of  weighing,  it  may  be  remembered  that  a  tablespoonful 
(heaped  up)  of  wheaten  flour  weighs  nearly  half  an  ounce,  and  a  heaped  dessertspoon- 
ful of  malt  flour  is  equal  to  the  same.  This  soup  is  as  sweet  as  milk  ;  and  after  boiling, 
may  be  kept  for  24  hours  without  undergoing  any  change. — This  is  an  excelbnit  food 
for  infants  who  cannot  be  suckled.  It  is  slightly  ajierient ;  so  that  children  under 
one  year  of  age  can  seldom  take  more  than  two  meals  of  it  in  the  day.  Where  there 
is  a  tendency  to  diarrhoea,  twenty  grains  of  prepared  chalk  may  be  substituted  for 
the  potash.  The  proportion  of  blood-forming  and  heat-producing  elements  is  the 
same  as  in  women's  milk  (1  :  3.8);  while  the  quantity  of  alkali  is  equivalent  to  that 
in  human  milk. 

The  solid  parts  of  this  food  are  sold,  ready  mixed  in  packets,  b}'  Mr.  Hooper,  of 
Pall-mall  East  and  Grosvenor  Street,  Mr.  Cooper,  of  26  Oxford  Street,  as  well  as  by 
many  other  chemists. 

19 


290  APPENDIX    OF    FORMULA. 


5.  Eggs,  Creavi,  and  Extract  of  Beef. 

Wash  two  ounces  of  the  best  pearl  sago  until  the  water  poured  from  it  is  clear. 
Then  stew  the  sago  in  half  a  pint  of  water  until  it  is  quite  tender  and  very  thick  : 
mix  with  it  half  a  pint  of  good  boiling  cream  and  the  yolks  of  four  fresh  eggs,  and 
mingle  the  whole  carefully  with  one  quart  of  good  beef  tea,  which  should  be  boiling. 
Serve. 

This  nourishing  broth  is  very  useful  in  many  cases  of  lingering  convalescence  after 
acute  disease. 

6.  Mutton  or  Veal  Broth— Beef  Tea. 

Take  of  mutton  or  veal  or  beef  one  pound  and  a  half,  cold  water  one  quart,  a  little 
salt,  and  rice  two  ounces.  Simmer  for  four  hours,  boil  for  a  few  minutes,  strain  and 
serve.  Another  excellent  plan  for  making  beef  tea  is  as  follows  :  Take  one  pound  of 
beef  minced  very  fine,  and  put  it  into  a  common  earthenware  teapot  with  a  pint  and 
a  half  of  cold  water.  Stand  the  pot  on  the  hob,  so  that  it  may  simmer  for  at  least 
three  hours.     About  three-quarters  of  a  pint  of  good  beef  tea  will  be  thus  obtained. 

Beef  tea  as  ordinarily  made,  and  preserved  meat-juice  of  all  kinds,  are  palatable 
but  not  very  nutritive  drinks.  A  pint  of  fine  beef  tea  contains  scarcely  a  quarter  of 
an  ounce  of  anything  but  water.  Nevertheless,  if  these  fluids  are  of  small  value  a8 
mere  nutrients,  perhaps  the  osmazome  and  salts  they  contain  may  possess  the  property 
(like  tea  and  coffee)  of  diminishing  the  waste  of  the  tissues.  It  has  been  proved  that 
dogs  die  slowly  if  fed  on  bread  and  gelatine  alone ;  but  when  greatly  reduced  by  this 
diet  they  soon  regain  flesh  and  strength  if  two  ounces  of  meat-tea  be  daily  added  to  it. 

Oruel  and  beef  tea  is  nourishing.  It  is  made  thus  :  Take  two  tablespoonfuls  of  oat- 
meal with  three  of  cold,  water,  and  mix  them  thoroughly.  Then  add  a  pint  of  strong 
boiling  beef  tea  (or  of  milk);  boil  for  five  minutes,  stirring  well  to  prevent  the  oat- 
meal from  burning ;  and  strain  through  a  hair  sieve. 

An  excellent  simple  restorative  during  convalescence  from  acute  disease  before 
solid  food  can  be  taken. 

7.  Spruce  Beer. 

The  essence  of  spruce  is  prepared  by  boiling  down  to  concentration  the  young 
branches  of  the  Black  Spruce  Fir  (Abies  Nigra).  Take  of  this  essence  half  a  pint; 
bruised  pimento  and  ginger,  of  each  four  ounces  ;  water  three  gallons.  Boil  for  five 
or  ten  minutes ;  then  strain,  and  add  eleven  gallons  of  warm  water,  a  pint  of  yeast, 
and  six  pints  of  molasses.  Mix,  and  allow  the  mixture  to  ferment  for  twenty-four 
hours. 

It  is  an  admirable  antiscorbutic,  and  is  an  agreeable  and  wholesome  drink  in  warm 
weather.  This  drink  was  found  very  eflScacious  by  Captain  Cook.  Dr.  Robert  Barnes 
suggests  that  it  should  be  used  in  the  Merchant  Service  instead  of  rum,  which  has 
no  antiscorbutic  virtue. 

8.    Tapioca  and  Cod-Liver. 

Boil  a  quarter  of  a  pound  of  tapioca  till  tender,  in  two  quarts  of  water  ;  drain  it  in 
a  cullender,  then  put  it  back  in  the  pan  ;  season  with  a  little  salt  and  pepper,  add  half 
a  pint  of  milk,  and  put  over  one  pound  of  fresh  cod  liver  cut  in  eight  pieces.  Set  the 
pan  near  the  fire  to  simmer  slowly  for  half  an  hour,  or  a  little  more,  till  the  liver  is 
quite  cooked.  Press  on  it  with  a  spoon,  so  as  to  get  as  much  oil  into  the  tapioca  as 
possible.  After  taking  away  the  liver,  mix  the  tapioca.  If  too  thick,  add  a  little 
milk,  then  boil  it  a  few  minutes  ;  stir  round,  add  a  little  salt  and  pepper,  and  serve. 
— Alexis  Soter. 

Tapioca  thus  cooked  is  nourishing  and  easily  digested. 

9.    The  Bran  Loaf. 

The  formula  used  by  Mr.  Camplin,  in  Diabetes^  is  as  follows :  Take  a  sufficient 
quantity  (say  two  or  three  quarts)  of  wheat  bran,  boil  it  in  two  successive  waters  for 
ten  minutes,  each  time  straining  it  through  a  sieve,  then  wash  it  well  with  cold  water 
(on  the  sieve),  until  the  water  runs  ofl"  perfectly  clear;  squeeze  the  bran  in  a  cloth  as 
dry  as  possible,  then  spread  it  thinly  on  a  dish,  and  place  it  in  a  slow  oven — if  put  in 
at  night  let  it  remain  until  the  morning,  when,  if  perfectly  dry  and  crisp,  it  will  be 
fit  for  grinding.  The  bran  thus  prepared  must  be  ground  in  a  fine  mill,  and  sifted 
through  a  wire  sieve  of  sufficient  fineness  to  require  the  use  of  a  brush  to  pass  it 


ALIMENTS.  291 

through:  that  which  does  not  pass  at  first  ought  to  be  ground  and  sifted  again,  until 
the  whole  is  soft  and  fine. 

Take  of  this  bran-powder  three  ounces  troy,  three  fresh  eggs,  one  ounce  and  a  half 
of  butter,  and  rather  less  than  half  a  pint  of  milk  ;  mix  the  eggs  with  part  of  the 
milk,  and  warm  the  butter  with  the  other  portion  ;  then  stir  the  whole  well  together, 
adding  a  little  nutmeg  and  ginger,  or  any  other  agreeable  spice.  Immediately  before 
jiutting  into  the  oven,  stir  in  first  thirty-five  grains  of  sesquicarbonate  of  soda,  and 
then  tliree  drachms  of  dilute  hydrochloric  acid.  The  loaf  thus  prepared  should  be 
baked  in  a  basin  (previously  well  buttered)  for  about  an  hour  or  rather  morg. 

Biscuits  may  be  prepared  as  above,  omitting  the  soda  and  hydrochloric  acid,  and 
part  of  the  milk,  and  making  them  of  proper  consistence  for  moulding  into  shape. 

If  properly  baked,  the  loaves  or  biscuits  will  keep  several  days,  but  should  always 
be  preserved  in  a  dry  place,  and  not  be  prepared  in  too  large  quantities  at  a  time. 

10.    White  Wine  Whey, 

To  half  a  pint  of  boiling  milk,  add  one  or  two  wineglassfuls  of  sherry  or  Madeira. 
The  curd  is  to  be  separated  by  straining  through  a  fine  sieve  or  piece  of  muslin. 
Sweeten  the  whey  with  refined  sugar. 

11.    Caudle. 

Beat  up  one  egg  with  a  wineglassful  of  sherry,  and  add  it  to  half  a  pint  of  fine  hot 
gruel.     Flavor  with  sugar,  nutmeg,  and  lemon-peel. 
In  insomnia  with  debility. 

Beat  up  two  tablespoonfuls  of  cream  in  a  pint  of  thin  cold  gruel.  Add  to  this  one 
tablespoonful  of  curacoa  or  noyeau,  and  a  wineglassful  of  sherry.  Flavor  with  sugar- 
candy,  and  let  half  a  tumblerful  be  taken,  cold,  at  intervals. 

12.  Ferruginous  Chocolate. 

Spanish  chocolate  16  oz.  ;  carbonate  of  iron  half  an  ounce.     Divide  into  one-ounce 
cakes.     One  to  be  dissolved  in  half  a  pint  of  hot  milk,  and  taken  night  and  morning. 
In  anemia,  amenorrhcea,  &c. 

13.  Iceland  Moss  and  Quinine  Jelly. 

Take  of  Iceland  moss  (Cetraria),  and  Irish  Moss  (Chondrus  crispus,  Carragheen), 
each  one  ounce.  Boil  slowly  for  three-quarters  of  an  hour  in  a  pint  and  a  half  of 
milk,  strain  through  muslin,  and  add  three  ounces  of  white  sugar  dissolved  in  one 
ounce  of  the  compound  tincture  of  quinia  (equal  to  eight  grains  of  the  salt).  A 
dessertspoonful  to  be  taken  frequently  in  the  course  of  the  day. 

In  phthisis,  tabes  mesenterica,  &c. 

14.  Lime-water  and  Milk. 

R.  Liquoris  Calcis  Saccharati,  fl.  drs.  j — iv ;  Lactis,  ad  fl.  oz.  4.     Mix. 

This  compound  will  sometimes  be  retained  when  all  other  food  is  ejected.  As  a 
variety,  milk  and  soda-water,  in  equal  proportions,  may  also  be  ordered.   (See  F.  73.) 

It  may  be  well  to  remember  that  the  addition  of  grs.  15  of  Bicarbonate  of  Soda 
to  the  quart  of  milk  not  only  prevents  it  from  turning  sour,  but  renders  it  more  di- 
gestible. 

15.  Artificial  Ass's  and  Goat's  Milk. 

Take  half  an  ounce  of  gelatine,  and  dissolve  it  in  half  a  pint  of  hot  barley  water. 
Then  add  an  ounce  of  refined  sugar,  and  pour  into  the  mixture  a  pint  of  good  new 
cow's  milk. 

Chop  an  ounce  of  suet  very  fine,  tie  it  lightly  in  a  muslin  bag,  and  boil  it  slowly 
in  a  quart  of  new  milk.     Sweeten  with  white  sugar,  or  a  glass  of  an\'  liqueur. 

An  excellent  aliment  in  some  cases  of  tabes  mesenterica,  &c.,  where  the  unpleasant 
odor  of  goat's  milk  prevents  it  being  taken. 


292  APPENDIX    OF    FORMULAE. 


16.  Milk,  Flour,  and  Steel. 

Beat  up  carefully  one  tablespoonful  of  flour,  one  raw  egg,  and  about  twenty  grains 
of  the  saccharated  carbonate  of  iron,  with  half  a  pint  of  new  milk  :  flavor  with  nut- 
meg and  white  sugar.     To  be  taken  for  lunch  with  a  biscuit. 

In  the  early  stages  of  tuberculosis  the  author  has  found  this  mixture  very  valuable. 

17.  Brandy  and  Egg  Mixture. 

Take  the  whites  and  yolks  of  three  eggs  and  beat  them  up  in  four  ounces  of  plain 
water.  Add  slowlj'  three  or  four  ounces  of  brandy,  with  a  little  sugar  and  nutmeg. 
This  form  is  preferable  to  that  in  the  London  Pharmacopoeia  for  1851.  Two  table- 
.spoonfuls  should  be  given  every  four  or  six  hours.  In  some  cases  of  great  prostration 
the  efficacy  of  the  mixture  is  much  increased  by  the  addition  of  one  drachm  of  the 
tincture  of  yellow  cinchona  to  each  dose. 

18.  Bread  Jtlly. 

Take  a  quantity  of  the  soft  part  of  a  loaf,  break  it  up,  cover  it  with  boiling  water, 
and  allow  it  to  soak  for  some  hours.  The  water — containing  all  the  noxious  matters, 
with  which  the  bread  may  be  adulterated — is  then  to  be  strained  ofl'  completely,  and 
fresh  water  added;  place  the  mixture  on  the  fire,  and  allow  it  to  boil  for  some  time 
until  it  becomes  smooth ;  the  water  is  then  to  be  pressed  out,  and  the  bread  on  cooling 
will  form  a  thick  jelly.  Mix  a  portion  of  this  with  sugared  milk  and  water,  for  use 
us  it  is  wanted. — Dr.  Churchill. 

A  good  food  for  infants  at  the  time  of  weaning,  for  children  with  acute  disease,  &c. 

19.  Nutritious  Demulcent  Drinks. 

Mix  together  half  a  pint  of  Mucilago  Acacise,  Mistura  Amygdalae,  and  pure  milk  ; 
sweeten  with  sugar-candy  or  honey;  and  add  one  large  tablespoonful  of  any  liqueur. 
Allow  the  whole  to  be  taken  during  the  day. — Or,  a  large  pinch  of  isinglass  may  be 
boiled  with  a  tumlilerful  of  milk,  half  a  dozen  bruised  almonds,  and  two  or  three 
lum[)s  of  sugar.     To  be  taken  warm  once  or  twice  in  the  day. 

These  drinks  are  very  grateful  in  cases  of  tonsillitis,  ulceration  of  the  pharynx,  &c. ; 
also  in  some  cases  of  debility  with  irritability  of  the  stomach,  and  a  tendency  to 
diarrhoea. 

20.  Indian  Sarsaparilla  and  Barley  Water. 

R.  Syrupi  Hemidesmi,  fl.  oz.  ij :  Glycerini,  fl.  oz.  j  ;  Decocti  Hordei,  fl.  oz.  ix. 
Mix,  and  direct  twotablespoonfuls  to  be  taken  frequently.  An  agreeable  demulcent, 
slightly  alterative,  and  diaphoretic  mixture. 

Usettal  in  the  eruptive  fevers,  and  in  inflammations  of  the  mucous  membranes. 

21.  Beef  Tea  and  Cream  Enemata. 

An  excellent  nutritious  enema  may  be  made  by  mixing  together  from  four  to 
eight  ounces  of  strong  beef  tea,  an  ounce  of  cream,  and  half  an  ounce  of  brandy  ur  an 
ounce  and  a  half  of  port  wine.  It  may  be  administered  twice  or  thrice  in  the  course 
of  twenty-four  hours. 

In  cases  of  acute  gastritis,  carcinoma  of  the  stomach,  obstinate  vomiting,  «&c., 
where  it  is  necessary  to  avoid  giving  food  by  the  mouth. 

Another  form  may  run  thus :  Take  four  or  six  ounces  of  restorative  soup  (F.  2), 
one  ounce  of  cream,  two  teaspoonfuls  of  brandy,  ten  or  fifteen  minims  of  liquid  ex- 
tract of  opium,  and  ten  grains  of  citrate  of  iron  and  quinia. 

22.   Cod-Liver  Oil  and  Bark  Enema. 

Take  four  ounces  of  essence  of  beef  (F.  3),  two  ounces  of  port  wine,  an  ounce  of 
cod-liver  oil,  two  drachms  of  tincture  of  yellow  cinchona,  and  twenty  minims  of 
liquid  extract  of  opium.     Mix.     To  be  administered  every  twelve  hours. 

23.    Quinine  and  Beef  Enema. 

Take  one  tablespoonful  of  brand}',  five  grains  of  suljihate  of  quinia,  one  teaspoonful 
of  glycerine,  two  tablespoonfuls  of  cream,  and  from  four  to  eight  ounces  of  restorative 


ALTERATIVES    AND    RESOLVENTS.  293 

soup  (F.  2).  Mix.  This  enema  may  be  administered  every  six  or  eight  hours.  Where 
the  rectum  is  very  irritable,  or  it  is  necessary  to  relieve  ])ain,  from  fifteen  to  twenty 
minims  of  the  liquid  extract  of  opium  may  be  advantageously  added. 


II.  ALTERATIVES  AND  RESOLVENTS. 

24.   Compound  Pill  of  Calomel  and  Opium. 

R.   Pilulae  Calomelanos  Compositse,  gr.  5;  Extracti  Opii,  gr.  ^.     Make  a  pill,  and 
direct  it  to  be  taken  every  night,  or  night  and  morning. 
In  disorders  dependent  on  a  venereal  taint. 

25.  Calomel  and  Opium. 

R.  Calomelanos,  gr.  2;  Pulveris  Opii,  gr.  \;  Confectionis  Kosae  Gallicae,  sufficient 
to  make  a  pill.     To  be  taken  every  four  hours. 

As  an  alterative,  when  it  is  wished  to  get  the  system  quickly  under  the  influence 
mercury. 

26.  Mercury  and  Conium. 

R.  Hydrargyri  cum  Creta,  gr.  2;  Extracti  Conii,  gr.  3.  Mix,  and  form  a  pill  to 
be  taken  three  times  a  day. 

In  syphilitic  tubercular  diseases. 

27.   Corrosive  Sublimate. 

• 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  1  ;  Ammonias  Hydrochloratis,  gr.  5;  Ex- 
tracti Sarsa3  Liquidi,  fl.  drs.  xij  ;  Decocti  Sarsae  Compositi,  ad  fl.  oz.  xij.  Mix.  Di- 
rect,— "  Two  small  tablespoonfuls  to  be  taken  three  times  a  day." 

In  confirmed  constitutional  syphilis;  as  well  as  in  some  forms  of  eczema,  prurigo, 
follicular  vaginitis,  chronic  metritis,  &c. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  1  ;  Glycerini,  fl.  oz.  j  ;  Tincturte  Cinchonae 
Composit;e,  ad  fl.  oz.  iij  ;  Olei  Mentha^  Piperitte,  min.  xxv.  Mix.  Direct, — "One 
teaspoonful  in  a  wineglassful  of  water  three  times  a  day." 

In  constitutional  syphilis,  and  some  forms  of  hemorrhage. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  1  ;  Extracti  Opii,  gr.  3 — 6;  Guaiaci  Re- 
sinae,  gr.  100  ;  Glycerini,  sufficient  to  make  a  mass.  Divide  carefully  into  twenty- 
four  pills,  and  order  two  to  be  taken  three  times  a  day. 

In  some  varieties  of  chronic  rheumatism. 

28.  Mercury^  Squills,  and  Digitalis. 

R.  Pilulae  Hydrargyri,  gr.  3;  Pulveris  Digitalis,  gr.  i;  Pulveris  Scillae,  gr.  1|' 
Mix,  and  form  a  pill  to  be  taken  twice  or  three  times  a  day. 
As  an  alterative  and  diuretic,  in  some  cases  of  dropsy. 

29.  Bromide  of  Mercury  and  Sarsaparilla. 

R.   Hydrargyri  Bromidi,  gr.  ^;  Extracti  Sarsas  Liquidi,  fl.  drs.  ij  ;  Decocti  Sarsae 
Compositi,  ad  fl.  oz.  iss.     Mix.     To  be  taken  three  times  a  day. 
In  syphilitic  lepra,  and  secondary  syphilitic  eruptions. 

30.  Podophyllum  Peltafum.,  or  May-Apple. 

R.  Podophylli  Resinae,  gr.  ^ — J;  Pulveris  Ipecacuanhae,  gr.  J;  Extracti  Gentiana) 
gr.  3.     Mix.     Make  a  pill,  to  be  taken  twice  or  thrice  daily. 

In  syphilis,  scrofula,  jaundice  from  suppression,  skin  diseases,  &c.  As  a  simple 
alterative  it  is  perhaps  as  valuable  as  mercury,  without  possessing  any  injurious 
qualities.  One  or  two  grains  of  quinine  may  be  advantageously  added  to  each  pill, 
where  there  is  general  debility.     See  E.  160. 


294  APPENDIX    OF    FORMULA. 


31.  Iodide  of  Potassium  llixtures. 

R.  Potassii  lodidi,  gr.  20 — 30  ;  Tincturse  SerpentariiB,  fl.  drs.  iij  ,  Misturas  Guaiaci, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  to  be  taken  three  times  a  day. 
Valuable  in  chronic  rheumatism,  and  in  acute  tonsillitis. 

R.  Potassii  lodidi,  gr.  20;  Liquoris  Potassse,  fl.  drs.  ij  ;  Tincturse  Hyoscyami,  fl. 
drs.  iij  ;  Infusi  Cinchonse  Flavte,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times  a 
day. 

In  chronic  rheumatism  with  an  abundance  of  lithates  in  the  urine  ;  as  well  as  in 
some  cases  of  eczema,  &c. 

R.  Potassii  lodidi,  gr.  2;  Vini  Colchici,  min.  xv  ;  Tincturse  Aconiti,  min.  iij  — 
viij  ;  Infusi  Khei,  fl.  oz.  j.     Make  a  draught,  to  be  taken  three  times  a  day. 
In  chronic  gout. 

R.  Potassii  lodidi,  gr.  3 — 5;  Spiritus  Ammonite  Aromatici,  min.  xxx ;  Tincturae 
Belladonnte,  min.  v — xv  ;  Tincturaa  Cinchonse  Compositse,  fl.  drm.  j  ;  Aquie  Menthae 
Piperitfe,  ad  fl.  oz.  iss.     Make  a  draught,  to  be  taken  three  times  a  day. 

In  some  cases  of  asthma  the  author  has  found  remarkable  benefit  from  this  formula. 

R.  Potassii  lodidi,  gr.  15 — 30:  Vini  Colchici,  fl.  drs.  iss;  Tincturae  Hyoscyami, 
fl.  drs.  ij  ;  Magnesia?  Sulphatis,  gr.  220;  Infusi  Anthemidis,  ad  fl.  oz.  viij.  Mix, 
One-sixth  part  three  times  a  day. 

In  some  instances  of  gout  with  fever  and  constipation,  and  in  chronic  pleurisy  with 
effusion.     Also  in  cases  of  lead  and  mercurial  poisoning  occurring  in  gouty  subjects. 

R.  Potassii  lodidi,  gr.  40;  Tincturaa  Khei,  fl.  oz.  j  ;  Extracti  Sarsse  Liquidi,  fl.  oz. 
ij.  Mix.  Label, — "  A  small  teaspoonful  in  a  wineglassful  of  water  three  times  a 
day." 

In  follicular  inflammation  of  the  pharyngo-laryngeal  mucous  membrane,  &c. 

R.  Potassii  lodidi,  gr.  30 — 120;  Glycerini,  fl.  oz.  j  ;  Tincturas  Aconiti,  min.  xx  ; 
Vini  Ipecacuanha^  fl.  drs.  iss ;  Succi  Taraxaci,  fl.  drs.  vj  ;  Decocti  Sarste  Compositi, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  severe  gonorrhceal  rheumatism,  constitutional  syphilis,  bronchocele,  scrofulous 
sores,  aneurism,  &c. 

R.  Potassii  lodidi,  gr.  15;  Tincturae  Assafcetidsie,  fl.  drs.  iss  ;  Tincturaa  Senegse,  fl. 
drs.  iij;  Syrupi  Mori,  ad  fl.  oz.  iij.  Mix.  Label, — "One  teaspoonful  every  two, 
three,  or  four  hours." 

For  a  child  about  two  years  old,  sutfering  from  croup.  Also  in  cases  of  infantile 
pneumonia. 

32.  Iodide  of  Iron  Mixtures. 

R.  Perri  lodidi,  gr.  6 — 18;  Glycerini,  fl.  drs.  xij  ;  Infusi  Calumbte,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  three  times  a  day. 

In  the  early  stages  of  tuberculosis,  and  in  strumous  ulcers,  where  the  stomach  will 
not  tolerate  cod-liver  oil. 

R.  Potassii  lodidi,  gr.  30;  Ferri  et  Ammoniae  Citratis,  gr.  60;  Aqua?  Destillatae, 
fl.  drs.  ij  ;  Glycerini,  fl.  drs.  vj  ;  Olei  Menthse  Piperitse,  min.  x  ;  Olei  Morrhua3,  ad 
fl.  oz.  vj.     Mix.     One  tablespoonful  after  the  two  chief  meals  of  the  day. 

R.  Potassi    lodidi,  gr.  12;  Ferri   et  Quinise  Citratis,  gr.  30;  Tincture  Aconiti, 
min.  XXV  ;   Infusi  Chiratae,  fl.  oz.  vj.     Mix.     One-sixth  part  three  times  a  day. 
In  chronic  rheumatism  with  debility,  &c. 

R.  Tincturae  Ferri  Perchloridi,  Tincturao  lodi,  na  min.  x  ;  Aquaa  Camphoras,  fl. 
oz.  j.     Make  a  draught,  to  be  taken  tRree  times  a  day. 

Useful  in  strumous  afl"ections  of  the  cervical  glands,  mesenteric  disease,  and  some 
cutaneous  disorders. 

R.  Syrupi   Ferri   lodidi,  Extracti  Sarsae  Liquidi,  na  fl.  oz.  j.     Mix.     Direct, — 
«'  One  teaspoonful  in  two  tablespoonfuls  of  water  three  times  a  day." 
In  chronic  rheumatism,  old-standing  venereal  aflbctions,  &c. 

R.  Potassii  lodidi,  gr.  3— f! ;  Ferri  et  Ammonira  Citratis,  gr.  20;  Syrupi  Papa- 
veris,  fl.  drs.  iij  ;  Infusi  Quassias,  ad.  fl.  oz.  iv.  Mix.  One  tablespoonful  three  times 
a  day. 

For  children  with  tabes  mesenterica.  Useful  also  for  strumous  subjects  who  have 
had  ascarides. 


ALTERATIVES    AND    RESOLVENTS.  295 


33.  Iodide  of  Potassium  and  Mercury. 

R.  Ammoniaj  Carbonatis,  gr.  30;  Potassi  lodidi,  gr.  20;  Tincturae  Aconiti,  min. 
xxx;  Tinctura)  Cinchonte  Flava?,  fl.  drs.  vj ;  Aqua;  Montha;  Piperitie,  ad  fl.  oz.  viij. 
Mix.  Direct, — "One-sixth  part  three  times  a  day,  viz.:  at  9  a.m.,  2  p.m.,  and  7 
p.m." 

R.  Hydrargyri  lodidi  Viride,  gr.  2;  Extract!  Opii,  gr.  1;  Extract!  Hyoscyami, 
gr.  fi.  Mix,  divide  into  two  pills,  and  order  one  to  be  taken  every  night  at  11  o'clock 
as  long  as  the  mixture  is  continued. 

Very  useful  in  many  forms  of  constitutional  syphilis. 

34.  Mercury  and  Chalky  with  Dover's  Powder,  ^c. 

R.  Hydrargyri  cum  Greta,,  Pulveris  Ipecacuanhfe  cum  Opio,  aa  gr.  5.  Mix,  and 
make  a  powder  to  be  taken  every  eight  or  twelve  hours. 

In  diarrhcea  with  unhealthy  secretions,  and  in  mild  dysentery. 

R.  Sodas  Biearbonatis,  Hydrargyri  cum  Greta,,  aa  gr.  2;  Magnesias  Garbonatis,  gr. 
5.     Mix,  and  make  a  powder  to  be  taken  every  other  night. 

An  alterative  and  aperient  for  children,  where  there  is  great  acidity  of  the  secre- 
tions. 

35.   Chloride  of  Calcium. 

R.  Liquoris  Galcii  Chloridl  (Phar.  Dub.),  fl.  oz.  j  ;  Tincturae  Aurantii,  fl.  oz.  ij. 
Mix.     One  teaspoonful  in  a  wineglassful  of  water  three  times  a  day. 

As.  a  liquefacient  in  scrofula,  tabes  mesenterica,  bronchocele,  fibroid  tumors  of 
uterus,  &c. 

36.  Tar  Pills  and  Capsules. 

R.  Picis  Liquidae,  oz.  1;  Pulveris  Aromatici,  oz.  \.  Mix,  divide  into  five-grain 
pills,  and  order  two  or  three  to  be  taken  three  times  a  day. 

Tar  Capsules  are  made,  each  containing  about  six  grains.  Two  or  three  may  be 
taken  for  each  dose. 

In  some  chronic  skin  diseases,  pruritus  of  the  anus,  and  chronic  catarrhal  a9"ections. 

37.  Bromide  of  Ammonium^ 

R.  Ammonii  Bromidi,  gr.  12 — 60;  Infusi  Aurantii,  fl.  oz.  viij.  Mix.  Direct, — 
"One-sixth  part  to  be  taken  three  times  a  day,  an  hour  before  meals." 

Kecommended  by  Dr.  Gibb  for  diseases  in  which  the  nervous  system  is  function- 
ally involved, — as  epilepsy,  &c.  It  is  a  valuable  absorbent  in  glandular  enlargements, 
and  in  excessive  corpulency ;  while  it  has  also  a  peculiar  soothing  influence  upon  the 
mucous  membranes. 

R.  Ammonii  Bromidi,  gr.  24;  Aqua;,  fl.  oz.  ij.     Mix.     One  teaspoonful  in  a  small 
cup  of  sweetened  tea  three  times  a  day. 
For  an  infant  with  hooping-cough. 

38.  Iodide  of  Ammonium. 

R.  Ammonii  lodidi,  gr.  3 — 15;  Infusi  Cinchonas  Plavae,  fl.  oz.  i — ij.  Make  a 
draught,  to  be  taken  twice  or  thrice  daily  before  food. 

Very  valuable  in  strumous  enlargement  of  the  absorbent  glands.  The  dose  is  to 
be  graduated  according  to  the  patient's  age.  At  the  time  this  medicine  is  given 
internally,  an  ointment  of  the  iodide  of  ammonium  (gr.  60  to  lard  oz.  1)  should  be 
rubbed  into  the  swellings  night  and  morning. 

39.  Iodide  of  Sodium. 

R.  Sodii  lodidi,  gr.  60;  Decocti  Sarsae  Compositi,  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

As  an  antisyphilitic  where  the  iodide  of  potassium  disagrees.  Moreover,  it  will 
sometimes  eft'ect  a  cure  after  the  latter  has  failed  to  be  of  use. 


296  APPENDIX    OF   FORMULiE. 


40.  Benzoate  of  Ammonia. 

R.  AmmonijB  Benzoatis,  gr.  10 — 30;  Aqiue,  fl.  oz.  iss.  Mix.  To  be  taken  three 
times  a  day. 

In  chronic  bronchitis,  chronic  inflammation  of  the  bladder  with  alkaline  urine,  and 
in  cases  attended  with  the  copious  excretion  of  phosphates. 

41.   Creasote. 

R.  Creasoti,  min.  xx — xl ;  Pulveris  Aromatici,  gr.  80:  Mucilaginis  Acacise,  suffi- 
cient to  form  a  mass.  Divide  into  twenty  pills  and  order  one  or  two  to  be  taken 
three  times  a  day. 

In  some  forms  of  neuralgia,  chronic  bronchitis,  and  obstinate  vomiting  unconnected 
with  inflammation  or  organic  disease — such  as  sea-sickness.  After  taking  creasote 
for  a  short  time,  the  urine  occasionally  assumes  a  dirty  or  brownish-black  color. 
Inunction  with  tar  may  give  rise  to  the  same  eflect.  Under  these  circumstances, 
creasote  has  been  obtained  from  the  urine  by  distillation. 

In  the  officinal  Mistura  Creasoti  the  unpleasant  flavor  is  tolerably  well  disguised 
by  the  Spirit  of  Juniper.     Dose,  fl.  oz.  j — ij.     See  F.  90 

42.  Bromide  of  Potassium. 

R.  Potassii  Bromidi,  gr.  3 — 8;  Aqua3,  fl.  oz.  j.  Mix.  To  be  taken  three  times  a 
day. 

Efficacious,  according  to  the  late  Dr.  Kobert  Williams,  in  reducing  enlarged 
spleens. 

R.  Potassii  Bromidi,  gr.  60 — 90;  Potassii  lodidi,  gr.  12;  Potassse  Bicarbonatis, 
gr.  40;  Tincturse  Aurantii,  fl.  drs.  vj  ;  Aquas,  ad  fl.  oz.  viij.  Mix.  One-sixth  part, 
on  an  empty  stomach,  night  and  morning. 

The  favorite  remedy  in  epilepsy  (1865). 

R.  Potassii  Bromidi,  gr.  30 — 60;  Tincturae  Valerianatae,  Ammoniatse,  fl.  drs.  vj  ; 
Aqua3  Camphorae,  vel  Infusi  Chiratse,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three 
times  a  day. 

In  hysteria,  insomnia  due  to  nervous  irritability,  functional  disturbance  of  the 
uterine  functions,  spermatorrhoea,  &c. 

R.  Pulveris  Guaiaci,  gr.  40;  Potassii  Bromidi,  gr.  30;  Magnesise  Carbonatis,  gr. 
60.     Mix.     Divide  into  six  powders,  and  order  one  to  be  taken  three  times  a  day. 
Useful  in  cases  where  it  is  required  to  exert  a  sedative  action  on  the  sexual  organs. 

43.   Cruaiacum  Mixtures. 

R.  Tinctura3  Guaiaci  Amraoniataj,  fl.  drs.  iv  ;  Tincturse  Aconiti,  min.  xxx  ; 
Mucilaginis  Tragacanthse,  Aqua  Cinnamomi,  aa  fl.  oz.  iv.  Mix.  Two  tablespoon- 
fuls,  twice  or  three  times  a  day. 

In  the  chronic  rheumatism  of  old  and  weak  people.  Also  in  some  skin  diseases 
where  there  is  a  strumous  taint. 

R.  Extracti  Opii  Liquidi,  min.  xxx  ;  Tincturte  Quinaj  Compositae,  fl.  drs.  vj  ;  Mis- 
turte  Guaiaci,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  chronic  skin  diseases.     Guaiacum  has  also  been  highly  extolled  in  tonsillitis. 

R.  Sulphuris  Sublimati,  oz.  2;  Potassae  Tartratis  Acidae,  oz.  1;  Pulveris  Rhei, 
gr.  120 ;  Guaiaci  Resinae,  gr.  60 ;  Mellis,  lb.  j  ;  Myristicae,  unum  in  pulverem  redacti. 
Mix  thoroughly,  and  order  two  teaspoonfuls  to  be  taken  night  and  morning  until  the 
whole  is  consumed. 

This  compound  was  formerly  in  much  repute  for  the  cure  of  chronic  rheumatism  ; 
being  said  to  be  especially  useful  in  old-standing  cases,  when  the  skin  is  inactive  and 
the  intestinal  glands,  «&c.,  torpid.  It  was  well  known  under  the  name  of  the  "  Chel- 
sea Pensioner." 

44.    Quinine  and  Ipecacuan. 

R.  Quiniaj  Sulphatis,  gr.  8  ;  Pulveris  IpecacuanhiP,  gr.  24  ;  Pulveris  Ipecacuanha 
cum  Opio,  gr.  30;  Glycerini  sufficient  to  form  a  mass.  Divide  into  sixteen  pills,  and 
order  two  to  be  taken  every  three  or  four  hours. 

In  subacute  dysentery,  occurring  in  tropical  regions.     See  P.  384. 


ALTERATIVES   AND    RESOLVENTS.  297 

45.   Quinine  and  Belladonna. 

R.  Qiiinipe  Sulphatis,  gr.  2;   Extrnoti   BclladonnjB,  srr.  \  ;   Extract!  Opii.  ejr.  \ — 1 
Extrac'ti  Hyosoyami,  <i;r.  2.     Make  a  pill,  to  be  taken  evpry  six  or_ eight  hours. 
In  neuralgia,*pruritus  of  the  vulva,  carcinoma,  «S:c.     See  F.  383. 

46.  ColcMcum,  <f<?. 

R.  Calomelanos,  Extraoti  Colchici  Acetici,  Extract!  Aloes  'Barbadensis,  Pulveris 
Ipecaciianhie,  aa  gr.  1.  Make  a  pill,  to  be  taken  every  four  hours  until  the  bowels 
are  well  acted  upon. 

In  gout,  with  congestion  of  the  liver.  . 

R.  Extract!  Colchici  Acetici,  Extracti  Aconiti,  aa  gr.  1 ;  Pilulae  Hydrargyri,  gr.  3. 
Make  a  pill,  to  be  taken  every  night  at  bedtime. 

In  gout,  with  deficient  action  of  the  liver. 

R.  PotassiB  Citratis,  gr.  120;  Vini  Colchici,  fl.  drs.  j — i j  ;  Liquoris  Morphiae  Hy- 
drochloratis,  fl.  drm.  j  ;  Aqute  Camphora>,  ad.  fl.  oz.  viij.  Mix.  One-.sixth  part 
every  six  hours. 

In  some  forms  of  gout,  where  there  is  but  little  constitutional  depression. 

R.  Spiritus  Ammoniie  Aromatici,  fl.  drs.  vj  ;  Vini  Colchici,  fl.  drs.  ij — iv ;  Tinc- 
turie  Aurantii,  ad.  fl  oz.  ij.  Mix.  Direct, — "One  teaspoonful  in  half  a  bottle  of 
soda  water,  three  times  a  day." 

47.  Oxide  of  Silver. 

R.  Argenti  Oxidi,  gr.  1 — 2  ;  Pulveris  Aromatici,  gr.  2 ;  Extracti  Cannabis  Indicse, 
gr.  J;  Glycerini,  sufficient  to  make  a  pill.     To  be  taken  three  times  a  day. 
Of  doubtful  efficacy  in  dyspepsia,  pyrosis,  haemoptysis,  monorrhagia,  &c. 

48.  Sulphite  of  Soda,  ^c. 

R.  Sodae  Sulphitis,  gr.  30—60;  Infusi  Quassiae,  fl.  oz.  iss.  Mix,  and  make  a 
draught  to  be  taken  three  times  a  day. 

Dr.  Jknner. — In  diseases  of  the  stomach,  accompanied  by  the  formation  of  the 
sarcinae  ventriculi.  The  patient  should  eat  unfermented  bread  while  taking  this 
medicine. 

The  Sulphite  of  Magnesia  may  be  given  in  the  same  way,  with  the  object  of 
neutralizing  blood-poisons.  It  is  richer  in  sulphurous  acid  than  the  sulphite  of  soda, 
is  more  stable,  and  has  a  much  more  agreeable  taste.  This  salt  has  been  strongly 
recommended  by'Dr.  Polli,  of  Milan,  in  cases  of  pyaemia,  typhus,  puerperal  fever, 
hospital  gangrene,  dissecting  wounds,  glanders,  cholera,  «&c. 

49.  Benzoic  Acid. 

R.  Acidi  Benzoici,  gr.  3 — 20;  Theriacte  sufficient  to  form  one  or  more  pills. 

Administered  in  proper  doses,  three  or  four  times  a  day,  this  remedy  is  useful  in 
jaundice  from  suppressed  action  of  the  liver,  and  in  uraemia.  It  has  also  been  recom- 
mended in  some  cases  of  incontinence  of  urine  in  children.     See  F.  246. 

50.    Turpentine  Mixtures. 

R.  Olei  Terebinthinae,  fl.  oz.  j  ;  Vitelli  Unius  Ovi ;  beat  together  and  add  gradu- 
ally Misturifi  Amygdalje,  fl.  oz.  iv  ;  Syrupi  Aurantii,  fl.  oz.  ij  ;  Tincturfe  Lavandula? 
Compositae,  fl.  drs.  iv  ;  Olei  Cinnamomi,  guttai  iv.  Mix.  Two  tablespoonfuls  to  be 
taken  three  times  a  day. 

Carmichael. — Recommended  in  iritis,  where  the  use  of  mercury  is  contra- 
indicated. 

R.  Spiritus  ^Etheris,  fl.  drs.  ij  ;  Olei  Terebinthina?,  fl.  drs.  iss.  ;  Mucilaginis  Aca- 
ciae,  fl.  oz.  iij  ;  Aquae  Cinnamomi,"  ad  fl.  oz.  vj.  Mix.  Direct, — "One-sixth  part 
three  times  a  day." 

To  prevent  the  formation  of  gall-stones,  or  to  aid  in  dissolving  them.  The  utility 
of  this  mixture  is  doubtful. 

R.  Olei  Terebinthina?,  fl.  drs.  iss— iij  ;  Svrupi  Limonis,  fl.  drs.  vj ;  Mucilaginis 
Tragacanthie,  fl.  oz.  iij  ;  Aquae,  ad  fl.  oz.  vj!  Mix.  Direct,— "One-sixth  part  every 
four  or  six  hours." 


298  APPENDIX    OF    FORMULJi;. 

Useful  in  some  forms  of  hsematemesis,  hsemoptj'sis,  epistaxis,  purpura  hemorrha- 
gica, &c.  Its  effects  must  be  watched,  so  that  it  may  be  discontinued  directly  any 
unpleasant  results — such  as  strangury  or  severe  vomiting — arise. — If  the  symptoms 
are  very  urgent,  the  first  dose  of  the  turpentine  may  consist  of  fl.  drs.  iv — vj,  beaten 
up  with  mucilage;  the  succeeding  doses  being  according  to  the  formula.  In  some 
cases  the  turpentine  may  be  advantageously  given  with  gallic  acid,  or  the  tincture 
of  the  perchloride  of  iron,  or  with  the  acid  infusion  of  roses,  or  with  the  dilute  nitric 
acid.  A  drop  of  creasote  with  each  dose  materially  lessens  its  tendency  to  cause 
nausea. 

R.  Terebinthinae  Chiae,  gr.  2;  Pulveris  Ehei,  gr.  3;  Saponis  duri,  sufficient  to 
make  a  pill.     To  be  taken  twice  a  day.     See  F.  102. 

51.  Donovan  8  Triple  Solution. 

R.  Liquoris  Hydriodatis  Arsenici  et  Hydrargyri,  min.  xx — xxx  ;  Tincturse  Zingi- 
beris,  fl.  drm.  j  ;  Aqute,  fl.  oz.  j.  Make  a  draught,  to  be  taken  twice  a  day,  directly 
after  meals. 

Useful  in  lepra,  psoriasis,  &c. 

52.  Arsenical  Mixtures. 

R.  Liquoris  Arsenicalis,  min.  iij  ;  Tincturje  Lupuli,  min.  xxx;  Infusi  Quassioe,  fl. 
oz.  j.     Make  a  draught,  to  be  taken  three  times  a  day,  directly  after  meals. 

Very  useful  in  many  obstinate  cutaneous  diseases.  In  ague  the  quantity  of  arsenic 
must  be  trebled.  Under  any  circumstances,  the  dose  should  be  diminished  directly 
the  tongue  gets  thoroughly  coated  with  a  silvery-looking  fur,  or  the  conjunctivas  be- 
come irritable,  or  diarrhoea  sets  in,  or  gastric  pain  is  complained  of. 

R.  Liquoris  Sodae  Arseniatis,  m.  iij — v;  Vini  Colchici,  min.  x;  Tincturse  Cin- 
chonse  Compositte,  fl.  drm.  j ;  Tincturse  Aconiti,  min.  v  ;  Aquae,  ad  fl.  oz.  j.  Mix. 
To  be  taken  three  times  a  day,  directly  after  meals. 

In  some  forms  of  chronic  rheumatism,  &c. 

R.  Quiniie  Sulphatis,  gr.  20;  Liquoris  Arsenici  Chloridi  (Phar.  Lond.,  1851),  fl. 
drs.  iij — iv;  Acidi  Sulphurici  Aromatici,  fl.  drs.  ij  ;  Syrupi  Zingiberis,  ad  fl.  oz.  iij. 
Mix.  Label,—"  One  teaspoonful  in  two  tablespoonfuls  of  w^ater  directly  after  break- 
fast, dinner,  and  tea." 

In  severe  neuralgia,  chorea,  chronic  rheumatism,  asthma,  hay-fever,  and  intermit- 
tent fever.     See  F.  381,  399. 

R.  Liquoris  Arsenicalis  min.  xxx;  Tineturae  Cantharidis,  fl.  drm.  j;  Tincturse 
Aurantii,  fl.  drs.  vj  ;  Potassii  lodidi,  gr.  18 — 30;  Infusi  Aurantii,  ad  fl.  oz.  vj.  Mix. 
One-sixth  part  directly  after  the  two  chief  meals. 

Valuable  in  some  inveterate  cutaneous  diseases,  as  lupus,  lepra,  psoriasis,  &c. 

R.  Liquoris  Sodae  Arseniatis,  fl.  drs.  iss ;    Succi  Scoparii,  fl.  oz.  iij.     Mix.     One 
teaspoonful  three  times  a  day,  in  a  wineglassful  of  water. 
In  some  cases  of  dropsy  from  chronic  renal  disease. 

R.  Acidi  Arseniosi,  gr.  1;  Pulveris  Zingiberis,  gr.  40;  Extracti  Jalapae,  gr.  20; 
Pulveris  Tragacanthae  Compositi,  gr.  80;  Confectionis  Kosae  Caninae,  gr.  10.  Mix 
very  intimately,  divide  into  twenty  pills,  and  order  one  to  be  taken  three  times  a  day, 
immediately  after  meals. 

In  psoriasis,  chronic  eczema,  and  other  cases  where  it  is  desirable  to  administer 
arsenic  in  a  solid  form. 

53.   Green  Iodide  of  Mercury. 

R.  Hydrargyri  lodidi  Viride,  gr.  12;  Extracti  Lupuli,  gr.  60;  Extracti  Opii,  gr. 
2 — 5.  Mix.  Divide  into  twenty-four  pills,  silver  them,  and  order  one  to  be  taken 
three  or  four  times  in  the  day. 

The  green  iodide  of  mercury  (Syn.  Iodide  of  Mercury)  will  cure  some  of  the 
pustular  and  tubercular  diseases  of  the  skin,  as  well  as  certain  secondary  venereal 
ulcerations,  when  all  other  means  fail.     Sec  F.  33. 

R.  Hydrargyri  lodidi  Viride,  gr.  6  ;    Extracti  Conii,  gr.  30.     Mix.     Divide  into 
six  pills,  and  order  one  to  be  taken  every  night  at  bedtime. 
In  small  secondary  sj'philitic  ulcers  about  the  tongue. 


ALTERATIVES   AND   RESOLVENTS.  299 


54.  Red  Iodide  of  Mercury. 

R.  Ilydrarujyri  lodidi  Riibri,  gr.  2 — 3  ;  Mor])hi;c  Ilydrochloratis,  gr.  1  ;  Extnicti 
Gentiaiiio,  vel  Extracti  Conii,  gr.  40.  Mix.  Divide  into  twdvo  pills,  and  order  one 
to  be  taken  twice  a  day.  A  cou])lo  of  ounces  of  the  Compound  Decoction  of  Sansa- 
parilla  may  be  taken  with  each  pill,  or  an  ounce  of  the  Guaiac  Mixture. 

Useful  in  the  same  cases  as  demand  the  green  iodide  of  mercury.  The  red  iodide 
(Syn.  HiNiODiDE  of  Mercury),  is,  however,  less  likely  to  cause  gastric  irritation. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  1;  Ammonije  Hydrochloratis,  gr.  5; 
Potassii  lodidi,  gr.  40;  AquiB,  fl.  drs.  ij  ;  Extracti  Sarsaj  Liquidi,  ad  fl.  oz.  ij.  Mix. 
Label, — "A  small  teaspoonful  in  a  wineglassful  of  water  three  times  a  day." 

This  formula  gives  a  convenient  extemporaneous  mode  of  exhibiting  the  red  iodide 
of  mercurj'  in  a  fluid  form. 

R.  Hydrargyri  lodidi  Rubri,  gr.  3 ;  Potassii  lodidi,  gr.  60 — 120;  Spiritus  Vini 
Rectificati,  fl.  drm.  j;  Syrupi  Zingiberis,  fl.  drs.  iv ;  Aquae  Destillata?,  fl.  oz.  iss. 
Mix.     Label, — "  Thirty  drops  three  times  a  day  in  a  wineglassful  of  water." 

Mr.  Lakgston  Parker  says — and  the  author  can  confirm  the  remark — that  this, 
remedy,  used  in  conjunction  with  the  mercurial  vapor  bath,  produces  excellent  results 
in  some  obstinate  forms  of  tubercular  disease  of  the  skin  ;  as  well  as  in  secondary 
venereal  ulcerations,  proving  intractable  after  the  employment  of  other  remedies. 

55.  Red  Iodide  of  Mercury  and  Arsenic. 

R.  Hydrargyri  lodidi  Rubri,  gr.  1  ;  Potassii  lodidi,  gr.  120;  Liquoris  Arsenicalis  ; 
fl.  drs.  iss  ;  Tincturte  Lavanduhe  Compositse,  fl.  oz.  ij  ;  Spiritus  Chloroformi,  fl.  drs. 
iv  ;  Aquie,  ad  fl.  oz.  xij.  Mix;  and  direct, — "  One  tablespoonful  to  be  taken  three 
times  a  day,  immediately  after  food." 

In  psoriasis,  and  some  inveterate  squamous  and  tubercular  and  ulcerous  affections 
of  the  skin. 

56.  Puccoon  and  Iodide  of  Arsenic. 

R.  Sanguinarias  Canadensis,  gr.  12;  Arsenici  lodidi,  gr.  2;  Extracti  Conii,  gr.  40. 
Mix  carefully,  divide  into  twenty-four  pills,  and  order  one  to  be  taken  three  times  a 
day. 

Said  to  be  beneficial  in  cases  of  cancer. 

57.   Chloi'ide  of  Bromium. 

R.  Bromidi  Chloridi,  guttse  iij — iv  ;    Pulveris   Glycyrrhizae,  gr.  60.      Mix  inti- 
mately, and  divide  into  twenty  pills,  one  to  be  taken  twice  or  thrice  daily. 
Recommended  by  Landolfi  in  cancer. 

58.  Bael  and  Spirit,  of  Chloroform. 

R.  Extracti  Belfe  Liquidi,  fl.  oz.  ij  ;  Spiritus  Chloroformi,  fl.  oz.  j.     Mix.     Direct, 
— "  One  teaspoonful  in  a  cup  of  barlej''-water  three  or  four  times  a  day." 
Has  been  found  useful  in  diarrhoea  and  dysentery. 

59.  Nitrate  of  Silver. 

R.  Argenti  Nitratis,  gr.  1 ;  Extracti  Hyoscyami,  gr.  3.  Make  a  pill.  To  be  taken 
every  twelve  hours,  on  an  empty  stomach,  for  about  ten  days. 

In  cases  of  idiopathic  jaundice  dependent  upon  gastro-duodenal  disturbance  rather 
than  on  disease  of  the  liver. 

R.  Argenti  Nitratis,  gr.  3 — 12  ;  Micao  panis,  gr.  30.  Divide  into  twelve  pills,  and 
order  one  to  be  taken  three  times  a  day. 

In  progressive  locomotor  atax}',  &c.     See  F.  419. 

The  gums  should  be  watched,  as  the  gingival  mucous  membrane  becomes  discol- 
ored before  the  skin  is  affected.  There  is  consequently  time  to  prevent  the  latter  by 
discontinuing  the  silver  salt. 

60.  Hydroclilorate  of  Ammonia. 

R.  Ammonias  Hydrocliloratis,  gr.  90;  Syrupi  Hemidesmi,  fl.  oz.  j;  Infusi  Dul- 
camarse,  ad  fl.  oz.  viij.     Mix.     Two  tablespoonfuls  every  six  hours. 
In  some  forms  of  chronic  rheumatism. 


300  APPENDIX    OF    FORMULA. 

R.  Liquoris  Ammonise  Acetatis,  min.  xxx ;  Ammonias  Hydrochloratis,  gr.  15. 
Aquae  Camphors,  fl.  oz.  ij.     Make  a  draught,  to  be  taken  every  four  hours. 

In  some  varieties  of  rheumatism,  phlegmasia  dolens,  thrombosis,  &c.,  where  the 
fibrine  of  the  blood  is  in  excess.  The  efficacy  of  this  remedy  is  increased  by  giving 
120  or  200  grains  of  the  Acid  Tartrate  of  Potash  (Syn.  Bitartrate  of  Potash)  in 
half  a  pint  of  water,  early  in  the  morning. 

R.  Ammoniae  Hydrochloratis,  gr.  20;  Extracti  Taraxaci,  gr.  15;  Tincturae  Gen- 
tianae  Compo.«it»,  fl.  drs.  iss ;  Infusi  Sennae,  ad  fl.  oz.  ij.  Make  a  draught,  to  be 
taken  twice  or  thrice  daily. 

In  some  cases  of  ascites  dependent  on  cirrhosis,  in  jaundice,  in  diminished  secre- 
tion of  bile,  &c. 

61.   Chlorate  of  Potash. 

R.   Potassae  Chloratis,  gr.  120;  Aquae  Camphorae,  vel  Infusi  Cinchonae  Flavte,  fl. 
oz.  viij.     Mix.     One-sixth  part  every  four  or  six  hours. 
In  inflammatory  aff'ections  of  the  mouth. 

R.  Potassae  Chloratis,  gr.  90;  Spiritus  ^theris,  fl.  drs.  iij ;  Infusi  Chiratae,  ad  fl. 
oz.  iv.     Direct, — "  One  tablespoonful  in  a  wineglassful  of  water,  three  times  a  day." 


III.  ANTACIDS. 

62.  Carbo7iate  of  3Iagnesia. 

R.  Magnesias  Carbonatis,  gr.  80;  Extracti  Opii  Liquid!,  min.  xxx;  Spiritus 
^theris,  fl.  drs.  iij  ;  Aquae  Menthae  Viridis,  ad  fl.  oz.  vj.  Mix.  One-fourth  part 
occasionally. 

Useful  where  there  is  much  oppression  from  flatulence. 

R.  Magnesiae  Carbonatis,  Sodae  Bicarbonatis,  aa  gr.  15;  Infusi  Serpentarise,  fl.  oz. 
iss      Make  a  draught,  to  be  taken  twice  or  thrice  daily. 
In  chronic  urticaria. 

63.  Ammonia  and  Chiretta. 

R.  Ammoniae  Carbonatis,  gr.  5;   Tincturae  Aurantii,  fl.  drm.  j  ;  Infusi  Chiratae,  fl. 
oz.  j  ;  Aquae,  ad  fl.  oz.  ij.     Make  a  draught,  to  be  taken  night  and  morning. 
A  good  remedy  in  dyspepsia,  with  acid  eructations  and  debility. 

64.  Preparations  of  Lithia. 

R.  Lithiae  Carbonatis,  gr.  3 — 6;  Aquae,  fl.  oz.  j.  Make  a  draught,  to  be  taken 
twice  a  day.     It  is  an  improvement  to  add  it  to  a  bottle  of  soda  water. 

Dr.  Garrod  speaks  highly  of  this  remedy  in  cases  of  the  uric  acid  diathesis,  and 
in  chronic  gout.  Where  uric  acid  gravel  is  being  voided,  it  causes  a  marked 
improvement.  The  carbonate  of  lithia  exists  in  many  of  the  continental  springs — 
as  Carlsbad,  Marienbad,  Kreuznach,  Aix-la-Chapelle,  Kissingen,  Ems,  Vichy,  Ba- 
den-Baden, &c. 

R.  Lithia?  Citratis,  Magnesiae  Carbonatis,  aa  gr.  10.  Make  a  powder,  to  be  taken 
twice  daily. 

In  chronic  gout. 

65.  Bismuth,  ivith  Magnesia  or  Soda. 

R.  Bismuthi  Albi,  Magnesiae  Carbonatis,  aa  gr.  10.  Make  a  powder,  to  be  taken 
in  half  a  bottle  of  soda  water  three  times  a  day. 

R.  Bismuthi  Albi,  gr.  15;  Sod*  Bicarbonatis,  gr.  12;  Pulveris  Tragacanthaj 
Compositi,  gr.  GO.  Make  a  powder,  to  be  taken  twice  or  thrice  in  the  twenty-four 
hours,  in  a  wineglassful  of  brandy  and  water. 


ANTISEPTICS.  301 

R.  Liquori.-i  Bismuthi,  fl.  drm.  j  ;  Inftisi  Quassia',  fl.  oz.  j.  Make  a  drauirht,  to  be 
taken  tlirci"  times  a  day.  One  drachm  of  the  solution  of  bismuth  is  equal  to  twenty 
grains  c)f  the  powder. 

These  preparations  are  very  useful  in  pyrosis,  gastrodynia,  and  many  diseases  of 
the  stomach,  caeum,  «fec.     See  also  F.  112. 

66.   Chalk  Mixture  and  Hops. 

R.  Tinctursp  Lupuli,  fl.  drs.  vj  ;  Tincturse  Cardamorni  CompositiP,  fl.  drs.  iv  ;  Vini 
IpecaeimnhiB,  fl.  drs.  ij  ;  Extracti  Opii  Liquidi,  min.  xxv  ;  Misturaj  Cretae,  ad  fl.  oz. 
vj.     Mix.     One  tablespoonful  every  three  or  four  hours. 

In  diarrha?a  due  to  acidity  of  the  prinise  vise. 

67.  Potash  and  Ammonia. 

R.  PotassiB  Bicarbonatis,  gr.  120;  Spiritus  Ammoniae  Aromatici,  fl.  drs.  iij  ;  Tine- 
tune  Aconiti,  min.  xxx ;  Infusi  Lupuli,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three 
times  a  day. 

In  gastrodynia. 

68.  Ammonia,  Potash,  and  Bark. 

R.  ATnmoni!eCarbonatis,gr.  30;  Potassaj  Chloratis,  gr  90;  Extracti  Opii  Liquidi, 
min.  xxx ;  Decocti  Cinchona}  Flavae,  fl.  oz  viij.  Mix.  One-sixth  part  three  times 
a  day. 

In  debility  with  acid  secretions. 

69.  ^Solution  of  Potash  and  Buchu. 

R.   Liquoris  Potassse,  min.  x — xv ;   Tincturje  Hyoscyami,  min.  xx  ;   Infusi  Bucco, 
fl.  oz.  iss.     Make  a  draught,  to  be  taken  three  times  a  day. 
In  catarrl)  and  irritability  of  the  bladder. 

70.   Soda,  Morphia,  and  Dilute  Hydrocyanic  Acid. 

R.  Sodae  Bicarbonatis,  gr.  15;  Liquoris  Morphias  Hydrochloratis,  min.  xv;  Acidi 
Hydrocyanici  Diluti,  min.  v;  Infusi  Cascarillse,  fl.  oz.  j.  Make  a  draught,  to  be  taken 
immediately. 

In  gastrodynia,  &c.,  after  the  stomach  has  been  emptied  by  an  emetic.  In  angina 
pectori.s,  immediately  after  a  paroxysm. 

71.  Potash  and  Aloes. 

R.  Potassse  Bicarbonatis,  oz.  J;  Tincturise  Chiratie,  fl.  drs.  ij ;  Decocti  Aloes  Com- 
positi,  fl.  oz.  viij.     Mix.     Take  one-.sixth  part  early  every  morning. 
In  chronic  gout. 

72.  Bicarbonate  of  Potash. 

R.  Potassas  Bicarbonatis,  gr.  30;  Aquaj,  fl.  oz.  iss.  Make  a  draught,  to  be  taken 
every  two  hours. 

In  acute  rheumatism,  continuing  the  medicine  until  the  joints  are  free  from  pain. 
It  generally  renders  the  urine  alkaline  in  twenty-four  hours. 

73.  Potash  and  Lime  Water. 

R.  Liquoris  Potassse,  min.  xv — xlv ;  Liquoris  Calcis  Saccharati,  fl.  drs.  ij.  Mix. 
To  be  taken  in  a  cupful  of  beef-tea,  or  of  milk,  two  or  three  times  a  day.     See  E.  14. 


IV.  ANTISEPTICS. 

74.  Artificial  Disinfectants. 

The  most  useful  agents  are — chloride  of  lime,  quick  lime,  and  permanganate  of 
potash.  In  certain  cases  the  perchloride  of  iron,  sulphate  of  iron,  ammonia,  iodine, 
and  chloride  of  zinc  are  applicable ;  or  chlorine  gas,  or  sulphurous  acid  gas  (obtained. 


302  APPENDIX    OF    FORMULA. 

by  burning  a  couple  of  ounces  of  flowers  of  sulphur  in  a  pipkin),  may  be  employed ; 
or  powdered  charcoal  can  be  tried. 

No  night-stool  or  bed-pan  should  be  used,  especially  in  hospitals,  without  its  con- 
taining the  solution  of  permanganate  of  potash,  or  some  chloride  of  lime,  or  chloride 
of  zinc,  or  carbolic  acid,  or  half  an  ounce  of  tincture  of  iodine.  The  first  has  the 
advantage  of  not  being  corrosive,  but  the  last  is  one  of  the  most  efficacious. — To  re- 
move quickly  any  unpleasant  smell  from  the  sick-room,  dried  lavender  or  cascarilla 
bark  may  be  burnt,  while  the  door  and  window  must  be  opened,  so  as  to  allow  of  a 
free  current  of  pure  air. 

To  disinfect  linen  and  washing  apparel  they  should  be  soaked  in  a  mixture  of  two 
ounces  of  the  solution  of  permanganate  of  potash  to  the  gallon  of  water,  and  after- 
wards in  boiling  water.  Woollens,  bedding,  or  clothing  may  be  thoroughly  purified 
by  exposing  them  for  about  two  hours,  in  an  oven,  to  a  temperature  of  220°  F. 

75.   Chlorine  Gas. 

As  a  fumigating  agent,  antiseptic  and  disinfectant,  chlorine  stands  unrivalled. 
The  ingredients  for  producing  it  should  be  contained  in  saucers  placed  in  the  higher 
parts  of  tlie  room,  as  the  gas  which  is  developed  will  descend  by  its  density,  and  soon 
become  mixed  with  the  surrounding  air.  Dr.  Faraday  adopted  the  following  method 
at  the  Millbank  Penitentiary  :  One  part  of  common  salt  was  intimately  mixed  with 
one  part  of  the  black  or  binoxide  of  manganese,  and  placed  in  a  shallow  eartheai  pan ; 
two  parts  of  oil  of  vitriol,  previously  diluted  with  two  parts  by  measure  of  water,  were 
then  poured  over  it,  and  the  whole  stirred  with  a  stick.  Chlorine  continued  to  be 
liberated  from  this  mixture  for  four  days. 

Another  plan  for  causing  the  free  evolution  of  chlorine  gas  is  the  addition  of  half 
a  pint  of  hydrochloric  acid  mixed  with  a  quarter  of  a  pint  of  water,  to  a  quarter  of  a 
pound  of  finely  powdered  black  oxide  of  manganese.  Whichever  mode  is  adopted  for 
producing  this  disinfectant,  it  is  necessary  while  employing  it  that  the  doors,  windows, 
and  chimney  of  the  room  be  kept  carefully  closed  for  some  hours. 

The  Chlorides  of  Lime  and  Soda,  when  exposed  to  the  air,  gradually  absorb  car- 
bonic acid  and  give  oft'  chlorine.  Hence  either  of  these  salts  can  be  used  as  disin- 
fecting agents.  Cloths,  dipped  in  an  aqueous  solution  of  chloride  of  lime,  may  be 
hung  up  in  an  inhabited  room  to  fumigate  it ;  the  quantity  of  chlorine  given  oflT  being 
too  small  to  be  mischievous.  It  was  probably  in  reference  to  these  .salts,  that  Aber- 
nethy  said  of  disinfectants, — "They  are  sometimes  very  useful,  very  useful  indeed; 
for  they  make  such  an  abominable  stink  that  the  patient  is  obliged  to  have  the  win- 
dows opened." 

76.  Solution  of  Chlorinated  Soda. 

R.  Liquoris  Sodae  Chloratse,  fl.  drs.  ij — iij  ;  Extracti  Opii  Liquidi,  min.  xxx ; 
Aqua?  Camphorse,  ad  fl.  oz.  viij.     Mix.     Two  tablespoonfuls  three  times  a  day. 

In  gangrene  of  the  lung,  low  fever,  &c.  It  not  only  relieves  the  fetor,  but  acts  as 
an  alterative,  &c.     If  necessary,  the  opium  can  be  omitted. 

77.   To  prepare  Chlorine  for  Internal  Administration. 

Put  eight  grains  of  chlorate  of  potash  in  a  strong  pint  bottle,  and  pour  upon  them 
one  drachm  of  strong  hydrochloric  acid.  Close  the  mouth  of  the  bottle  until  the 
violent  action  ceases,  when  add  one  ounce  of  water  and  agitate  well ;  add  another 
ounce,  again  shake,  and  continue  this  process  until  the  bottle  is  full.  One  or  two 
tablespoonfuls  may  be  taken  frequently  according  to  the  age.  An  adult  may  use  the 
whole  pint  in  one  day. 

The  dose  of  the  officinal  Liquor  Chlori  is  from  min.  xxx  to  fl.  drs.  ij  in  a  wine- 
glassful  of  water  several  times  daily. 

Useful  in  scarlet  fever,  t,yphus,  diphtheria,  chronic  aff'ections  of  the  liver,  &c. 

78.  Permaiiganate  of  Potash. 

The  permanganate  of  potash  is  an  excellent  disinfectant,  and  is  the  basis  of  Con- 
dy's  Antiseptic  Fluid.  The  latter  is  double  the  strength  of  the  officinal  Liquor 
PoTAssiK  Pkrmanganatis. 

From  fl.  drs.  j — vj  of  the  solution  of  permanganate  of  potash  in  one  pint  of  water, 
may  be  applied  to  all  kinds  of  suppui-ating  sores.    The  author  has  frequently  ordered 


ANTISEPTICS.  303 

such  a  lotion  with  great  benefit  to  destroy  the  horribly  offensive  odor  of  a  malignant 
nicer  ;  or  for  the  same  purpose  in  su})purating  scalds  and  burns.  The  solution  should  be 
made  only  of  such  a  strength  as  to  ln'  l)()rii(}  without  any  ])ain  or  even  uneasiness.  It 
must  be  frequently  sj-ringed  over  the  sores,  since  contact  with  lint  and  sponges 
decomposes  it.  Linen  is  stained  by  it,  but  the  discoloration  may  be  removed  b}'  sul- 
phate of  iron.  As  a  wash  for  stinking  feet,  or  for  the  removal  of  offensive  odors 
from  the  hands,  after  handling  morbid  specimens,  &c.,  the  liquor  ought  to  be  used  in 
the  proportion  of  one  fluid  drachm  to  the  ounce  of  distilled  water.  As  an  injec- 
tion in  cancer  of  the  uterus,  the  strength  ought  not  to  be  greater  than  half  a  fluid 
ounce  to  one  pint  of  water.  To  deprive  night-chairs  of  offensive  odor,  a  wineglass- 
ful  of  Condy's  Fluid  should  be  mixed  with  two  ])ints  of  fresh  or  salt  water,  and  put 
into  the  pan  previous  to  its  use. 

79.   Chloride  of  Zinc. 

This  substance  is  a  most  powerful  caustic,  which  has  long  been  used  to  destroy 
cancerous  and  other  growths.  It  has  been  administered  internally — dose,  gr.  1, 
largely  diluted — but  without  any  benefit.  It  forms,  however,  a  valuable  disinfectant 
gargle — gr.  10  to  water  fl.  oz.  viij  ;  or  in  still  larger  proportions  it  is  a  most  effica- 
cious antiseptic.  Sir  W.  Burnett's  Disinfecting  Fluid  consists  of  gr.  25  of  this  salt 
to  water  fl.  drm.  j.  For  use,  about  one  ounce  of  this  solution  is  added  to  two  pints 
of  water.  To  disinfect  a  sick-room,  a  piece  of  flannel  three  or  four  feet  square  is  to 
be  moistened  with  a  solution  thus  made,  and  frequently  waved  through  the  air. 
Some  of  it  should  also  be  [)laced  in  the  close-stools  and  bed-pans. 

80.   Chlorinated  Lime  Lozenges. 

R.  Calcis  ChloratiE,  gr.  60;  Sacchari  Albi,  oz.  4;  Amyli,  07..  1;  Olei  Menthse 
Piperitie,  fl.  drm.  j;  Pulveris  Tragacantha^  Compositi,  gr.  120;  Aquse  Menthie 
Piperitie,  sufficient  to  form  a  mass.  To  be  divided  into  lozenges  of  twenty  grains 
each. 

One  may  be  taken  frequently  to  remove  fetor  of  the  breath,  whether  due  to  mer- 
cury or  other  causes. 

81.  Iodine. 

This  agent  has  been  recommended  for  disinfecting  and  deodorizing  purposes  by 
Wynn  Williams,  Campbell  de  Morgan,  Nunn,  and  Richardson.  Two  hundred  grains 
are  placed  in  a  common  chip  box  and  suspended  over  the  patient's  bed,  or  they  may 
be  put  into  a  cup  or  saucer  on  the  mantel-shelf.  If  desired,  the  metal  may  be  at  once 
volatilized  and  the  vapor  diflused  through  the  apartment,  by  placing  it  on  a  heated 
fire-shovel.  In  rooms  occupied  by  small-pox  patients  the  air  may  be  kept  free  from 
smell  by  using  iodine  in  this  manner, — probably  the  strongest  proof  which  could  be 
adduced  of  the  value  of  this  simple  and  manageable  remedy. 

R.  Tinctvirse  lodi,  fl.  drs.  vj  ;  AquiB  Destillatte,  ad  fl.  oz.  viij.     Mix. 
Useful  as  a  lotion  to  unhealthy  ulcerations  with  offensive  discharges. 

82.  Extract  of  Logwood. 

R.  Extracti  Haematoxyli,  oz.  1 ;  Butyri  Cacao,  Adipis,  aa  oz.  \.     Mix. 

This  is  an  excellent  disinfectant  when  applied  to  malignant  sores  or  suppurating 
wounds.  The  remedy  is  equally  efficacious  when  used  as  a  lotion  or  powder.  If 
any  haemostatic  be  needed,  the  logwood  may  be  combined  with  tannin  or  perchloride 
of  iron. 

83.   Chlorate  of  Potash  Lozenges. 

R.  Potassse  Chloratis,  gr.  150;  Balsami  Tolutani,  gr.  35;  Spiritfts  Vini  Rectifi- 
cati,  sufficient  to  make  a  solution.  Then  add  Sacchari  Albi,  oz.  10;  Mucilaginis 
Acacije,  sufficient.  The  paste  thus  made  is  to  be  divided  into  50  lozenges,  each  of 
which  will  contain  three  grains  of  chlorate  of  potash,  and  nearly  one  of  balsam  of 
Tolu. 

Twelve  or  fifteen  may  be  taken  in  the  course  of  the  day,  to  remove  foulness  of  the 
breath.     These  lozenges  are  useful  also  in  healing  ulcerations  of  the  gums. 

84.  Bark  and  Camphor. 

R.  Spiritfis  CamphorEe,  min.  xx  ;  Spiritfis  Rectiflcati,  fl.  drm.  j  ;  Infusi  Cinchonae 
Flavie,  ad  fl.  oz.  iss.     Make  a  draught. 


304  APPENDIX    OF   FORMULA. 

To  be  taken  every  six  or  eight  hours  hy  a  nervous  attendant  in  a  sick-room.     Its 
efficacy  may  be  increased  by  the  occasional  addition  of  a  glass  of  port  wine. 


V.  ANTISPASMODICS. 

85.  Ether  Mixtures. 

R.  Spiritus  ^theris,  min.  xl — fl.  drm.  j;    Extracti   Opii   Liquidi,  min.  x — xv  ; 
Tinctuiie  Castorei,  ti.  drm.  j  ;  Aquifi  Menthaj  Piperita^  ad  fl.  oz.  iss.    Make  a  draught. 
To  be  taken  occasionally  when  the  system  is  oppressed  with  flatulence  or  spasms. 

R.  Spiritus  ^theris,  Spiritus  Chloroformi,  aa  fl.  drs.  iij  ;  Tincturse  Cardamom! 
Compositaj,  fl.  drs.  vj  ;  Spiritus  Myristicse,  fl.  drs.  ij  ;  Olei  Carui,  min.  xij  ;  Mucila- 
ginis  Tragacanthse,  fl.  oz.  iij  ;  Aquse  Mentliae  Piperita^,  ad  fl.  oz.  viij.  Mix.  Two  or 
three  tablespoonfuls  occasionally,  when  there  is  oppression  from  flatulence. 

R.  Spiritus  ^theris,  fl.  drs.  iss;  Spiritus  Ammonite  Aromatici,  fl.  drs.  ij  ;  Tinc- 
turic  Campliora3  cum  Opiu,  fl.  drs.  iss;  Aqu;*  Camphora?,  ad  fl.  oz.  iv.  Mix.  Label, 
— "Two  tablespoonfuls  everj'  half-hour,  until  the  pain  is  relieved." 

In  spasmodic  diseases,  angina  pectoris,  &c. 

86.  Ammonia  Mixtures. 

R.  Spiritus  Ammoniae  Aromatici,  fl.  drm.  j  ;  Acidi  Hydrocyanici  Diluti,  min.  iij 
— V  ;  Syrupi  Zingiberis,  fl.  drm.  j  :  Aquae  C|arui,  ad  fl.  oz.  iss.  Make  a  draught,  to 
be  taken  twice  or  thrice  a  day  if  there  be  flatulence  or  languor. 

In  dyspepsia,  or  debility  with  irritable  stomach.     See  F.  67,  08. 

R.  Tincturse  Assaftetida,  fl.  drs.  ij  ;  Ammonise  Carbonatis,  gr.  20;  Aquae  Cam- 
phorffi,  ad  fl.  oz.  iv.  Mix.  One  or  two  tablespoonfuls  occasionally  when  the  patient 
IS  feeling  languid  or  hysterical. 

R.  Spiritiis  Ammonise  Aromatici,  min.  xxx  ;  Magnesias  Carbonatis,  gr.  20;  Spiritus 
Chloroformi,  fl.  drm.  j  ;  Aquae  Menthae  Piperitse,  ad  fl.  oz.  iss.  Make  a  draught,  to 
be  taken  occasionally. 

In  severe  colic. 

R.  Spiritus  Ammonite  Aromatici,  fl.  drs.  iss;  Spiritfts  Etheris,  fl.  drm.  j  ;  Tinc- 
turae  Belladonnae,  min.  xij  ;  Acidi  Hydrocyanici  Diluti,  min.  viij  ;  Syrupi,  ad  fl.  oz. 
ij.     Mix.     One  teasp(^onful  in  the  same  quantity  of  water  every  four  hours. 

For  a  child  two  years  old  with  hooj)ing-cough. 

87.  Valerian  Drauglit. 

R.  Tincturae  Valeriana  Ammoniatte,  min.  xl ;   Iiafusi  Valeriana',  fl.  oz.  j.     Make 
a  draught,  to  be  taken  occasionally. 
In  hysteria. 

88.  Lobelia,  Ether,  ^c. 

R.  Tincturae  Lobelite  ^Ethere;«,  fl.  drs.  iij  ;   Vini  Ipecacuanhae,  fl.  drs.  ij  ;  Misturie 
Ammoiiiiici,  ad  fl.  oz.  vj.     Mix.     Two  tablespoonfuls  every  six  hours. 
In  the  dyspnoea  of  asthma,  when  there  is  vesicular  cmj.hysema. 

89.  Assafcetida  and  Chiretta. 

R.  Tinctura?  Assafcetidaj,  fl.  drs.  ij  ;  Spiritiis  Ammoniae  Aromatici,  fl.  drs.  iij; 
Tincturai  Chiratas,  fl.  drs.  vij.  Mix.  Direct, — "Sixty  drops  in  a  wineglassful  of 
water  every  two  or  three  hours,  until  the  paroxysms  cease." 

In  hysteria. 

90.  Aconite  and  Creasote. 

R.  Tincturae  Aconiti,  min.  xlv  ;  Misturae  Creasoti,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

In  some  cases  of  obstinate  sickness,  such  as  occur  during  pregnancy  and  in  hysteria. 
See  F.  41. 


ASTRINGENTS.  305 


91.  Nitric  Acid  3Iixture. 

R.  Acidi  Nitrici  Diluti,  fl.  clrs.  xij  ;  Tinctiirse  Cardamomi  Composita;,  fl.  drs.  iij  ; 
Syrupi,  fl.  oz.  iiiss  ;  Aquit',  fl.  oz.  j.  Mix.  One  or  two  small  teaspoonfuls  every  two 
hours. 

Dr.  Gibb  states  that  nitric  acid  i?  a  specific  in  the  treatment  of  hooping-cough, 
curing  the  disease  in  from  two  to  fifteen  days.     He  recommends  this  formula. 

92.  Sulphate  of  Zinc  and  Belladonna. 

R.  Zinei  Sulphatis,  gr.  8;  Extracti  Belladonnse,  gr.  2;  Aqu.ie,  fl.  oz.  iv.  Mix. 
Half  an  ounce  four  times  a  day. 

Dr.  Fuller. — For  a  child  above  three  years  of  age  with  hooping-cough.  Every 
other  day  the  strength  of  the  mixture  may  be  augmented  in  the  proportion  of  one 
dose.  The  belladonna  may  be  thus  gradually  increased  to  doses  of  five  grains  with- 
out any  mischief.     See  F.  3'26. 

93.    Valerianate  of  Quinia. 

R.   Quinia3  Valerianatis,  gr.  12 ;   Extracti  Gentian*,  gr.  40.     Divide    into    twelve 
pills,  silver  them,  and  order  one  to  be  taken  three  times  a  day. 
In  hysteria,  and  analogous  nervous  disorders. 

94.  Stramonium,  Colchicum,  and  Digitalis. 

R.  Potassse  Citratis,  gr.  120;  Tincturse  Stramonii,  fl.  drm.  j;  Tincturne  Colchici 
Scminis,  fl.  drs.  ij  ;  Infusi  Digitalis,  fl.  oz.  iij  ;  Aquae  Menthae  Piperitae,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  three  times  a  day. 

In  irregular  gout,  with  dyspnoea  or  violent  palpitation,  and  a  full  pulse. 

95.  Sumhul  and  Ether. 

R.  Sumbulii  Radicis,  gr.  240;  Spiritiis  ^theris,  fl.  oz.  iv.  Macerate  in  a  stoppered 
bottle  for  seven  days,  and  then  filter.     Dose,  min.  xx — xxx. 
In  neuralgia,  hysterical  fits,  «&c. 


VI.  ASTRINGENTS. 

96.  Rhatany  Mixtures. 

R.  Tincturse  Rhei,  fl.  drs.  iij  ;  Infusi  Krameria?,  fl.  oz.  viij.     Make  a  mixture,  and 
order  one-sixth  part  to  be  taken  every  six  or  eight  hours. 
A  valuable  astringent  in  common  diarrhoea. 

R.  Extracti  Kramerise,  gr.  20;  Aquie,  fl.  oz.  iss.  Make  a  draught,  to  be  taken 
three  times  a  day. 

In  hematuria,  passive  intestinal  hemorrhage,  «&c. 

R.  Potassae  Chloratis,  gr.  60  ;  Tincturae  Kramerite,  fl.  drs.  vj  ;  Aqu;e,  ad  fl.  oz. 
viij.     Mix.     One-sixth  part  three  times  a  day. 

In  relaxation  of  the  buccal  mucous  membrane,  sponginess  of  the  gums,  &c. 

97.   Catechu  Mixtures. 

R.  Tincturae  Catechu,  fl.  drs.  iij — vj  ;  Pulveris  Cretae  Aromatici,  gr.  90;  Olei 
Mentha;  Piperitae,  min.  vj  ;  Extracti  Opii  Liquidi,  min.  xxx;  Misturte  Uretffi,  ad.  fl. 
oz.  viij.     Mix.     One-sixth  part  after  every  relaxed  motion. 

Efficacious  in  checking  simple  diarrhoea.  In  some  instances  half  an  ounce  of  castor 
oil  should  be  given  four  hours  before  commencing  this  mixture. 

R.  Tincturae  Catechu,  fl.  drm.  j  ;  Acidi  Sulphuric!  Aromatici,  min.  xv  ;  Olei 
Menthae  Piperitae,  min.  j ;  Infusi  Catechu,  fl,  oz.  j.  Mix.  To  be  taken  two  or  three 
times  a  day. 

20 


306  APPENDIX    OF   F0RMUL.J1. 

R.  Tincturre  Catechu,  fl  drs.  iij  ;  Spirit^?  Chloroformi,  fl.  drs.  vj  ;  Extract!  Belee 
Liquida,  fl.  drs.  xij  ;  Infusi  Maticse,  ad  fl.  oz.  vj.  Mix.  Two  tablespoonfuls  to  be 
taken  three  or  four  times  a  day. 

In  chi-onic  diarrhoea  and  dysentery. 

R.  Pulveris  Catechu  Compositi,  gr.  30;  Pulveris  Cretaj  Aromatici  cum  Opio,  gr. 
20.     Make  a  powder  ;  to  be  taken  night  and  morning. 

98.    Vegetable  Charcoal. 

R.  Carbonis  Ligni,  Theriacse,  aa  oz.  1.  Mix.  Direct  one  teaspoonful  to  be  taken 
three  or  four  times  a  day. 

In  some  cases  of  chronic  diarrhoea,  when  the  irritation  is  kepit  up  by  fecal  fermen- 
tation. In  fetid  eructations.  The  charcoal  should  be  recently  prepared.  Charcoal 
biscuits  are  also  useful. 

99.   Tanniyi  and  Nitric  Acid. 

R.  Acidi  Tannici,  gr.  30 ;  Acidi  Nitrici  Diluti,  fl.  drm.  j  ;  Tincturfe  Lupuli,  fl. 
drs.  iv ;  Infusi  Gentianas,  ad  fl.  oz.  viij.  Mix.  Direct, — "One-sixth  part  three 
times  a  day." 

To  restrain  secretion  in  chronic  bronchial  catarrh,  in  phthisis  when  the  cavities 
are  large  and  the  w^alls  throw  out  considerable  quantities  of  purulent  matter,  in 
nervous  debility,  and  in  most  cases  where  an  astringent  is  required.  When  a  ferru- 
ginous tonic  is  indicated,  the  above  mixture  may  be  given  night  and  morning,  and 
some  preparation  of  steel  in  the  middle  of  the  day. 

100.  Aromatic  Sulphuric  Acid  and  Opium. 

R.  Acidi  Sulphurici  Aromatici,  fl.  drs.  ij ;  Tincture  Camphorje  cum  Opio,  fl.  oz. 
j  ;  Aquaj  Cinnamomi,  ad  fl.  oz.  viij.  Mix.  Label, — "  One-sixth  part  three  times  a 
day,  about  an  hour  before  each  meal." 

101.  Per  chloride  of  Iron. 

R.  Tincturse  Ferri  Perchloridi,  min.  xv ;  Acidi  Hydrochlorici  Diluti,  min.  x; 
Olei  Menthse  Piperitae,  min.  j  ;  Infusi  Quassias,  fl.  oz.  iss.  Make  a  draught,  to  be 
taken  every  six  hours. 

In  some  cases  of  epistaxis,  hemorrhage  from  the  stomach,  &c. 

102.    Oil  of  Turpentine. 

R.  Olei    Terebinthinse,    min.    x — xx ;    Misturae   Amygdalte,   fl.    oz.   j.     Make   a 
draught,  to  be  taken  every  hour. 
In  severe  haemoptysis  especially  where  the  individual  is  weak  and  cachectic. 

R.  Mucilaginis  Acaciae,  fl.  drs.  iv  ;  Sodas  Bicarbonatis,  gr.  10;  Olei  Terebinthinae, 
min.  X  ;  Olei  Anethi,  min.  j  ;  Aquaj  Destillatae,  ad  fl.  oz.  iss.  Make  a  draught  ;  to  be 
taken  thrice  daily. 

In  passive  haematemesis.     See  F.  50. 

103.   G-allic  Acid. 

R.  Acidi  Gallici,  gr.  10 — 15;  Aqua3  Destillatae,  fl.  oz.  iss.  Make  a  draught,  to  be 
taken  every  four  hours. 

R.  Acidi  Gallici,  gr.  4;    Extracti  Cannabis  Indicie,  gr.   J;    Confectionis   Eosae 
Gallicae,  gr.  1.     Make  a  pill,  to  be  taken  every  night  at  bedtime. 
To  check  the  night-sweats  in  phthisis. 

R.  Acidi  Gallici,  gr.  8;  Morphiae  Hydrochloratis,  gr.  \;  Confectionis  Kosse  Gal- 
lic*, sufficient  to  make  two  pills.     Label, — "  To  be  taken  every  night  at  bedtime." 
In  the  night-sweats  of  phthisis. 

R.  Acidi  Gallici,  gr.  15 — 25;  Acidi  Sulphurici  Aromatici,  min.  xv — xx  ;  Tinctura? 
Cinnamomi,  fl.  drs.  ij  ;  Aquae  Destillatae,  ad  fl.  oz.  ij.  Make  a  draught,  to  be  taken 
every  four  hours  until  the  bleeding  ceases. 

In  profuse  menorrhagia,  haemoptysis,  haematemesis,  &c. 


ASTRINGENTS.  307 

R.  Acidi  Gallici,  gi".  12;  Pulveris  Ipccacuanlije  cum  Opio,gr.  5.  Make  a  powder, 
to  be  taken  every  eight  or  twelve  hours. 

A  valuable  astringent  in  hemorrhage  from  the  lungs,  stomach,  intestines,  or 
kidneys. 

104.  Cinnamon  Mixtures. 

R.  Tincturfe  Cinnamomi,  fl.  drs.  vj  ;  Acidi  Nitrici  DiUiti,  fl.  drs.  ij.  Mix  and 
label, — "Thirty  drops  in  a  winogjassful  of  water  every  two  hours." 

Useful  in  passive  hemorrhages  from  the  kidneys,  bladder,  uterus,  &c.         . 

R.  Tinctune  Cinnamomi,  fl.  drs.  iv  ;  Spiritus  Ammonite  Aromatici,  fl.  drs.  ij  ; 
Decocti  Hiematoxyli,  ad  fl.  oz.  vj.  Mix.  One-fourth  part  after  every  relaxed  motion. 

R.  Tinctura3  Cinnamomi,  fl.  drs.  ij ;  Aqua^  Cinnamomi,  fl.  oz.  j.  Make  a  draught  ; 
to  be  taken  thrice  daily. 

In  menorrhagia  especially,  but  also  in  other  varieties  of  passive  hemorrhage.  See 
a  paper  by  the  author,  "  Lancet,"  15th  October,  1853. 

105.  Matico  and  Rhatany. 

R.  Tincturaj  Kramerise,  fl.  drs.  xij  ;  Syrupi  Papaveris,  fl.  drs.  vj  ;  Infusi  Maticae, 
ad  fl.  oz.  viij.     Mix.     One  tablespoonful  every  three  or  four  hours. 
In  the  diarrhoea  of  phthisis. 

106.  Sulphate  of  Qopper  and  Opium. 

R.  Cupri  Sulphatis,  Extract!  Opii,  aa  gr.  \;  Extract!  Gentiana),  gr.  3.     Make  a 
pill,  to  be  taken  three  times  a  day. 
In  obstinate  diarrhoea. 

107.  Nitrate  of  Silver  and  Opium. 

R.  Argenti  Nitratis,  gr.  ^;  Extract!  Opii,  gr.  2.  Make  a  pill,  to  be  taken  night 
and  morning. 

In  very  obstinate  diarrhcea  where  opium  agrees  with  the  system.     See  F.  59. 

108.  Kino  and  Logwood. 

R.  Tincturfe  Kino,  fl.  drs.  vj ;  Vini  Ipecacuanbfe,  fl.  drs.  ij  ;  Decocti  Ha3matoxyli, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 
In  chronic  dysentery,  diarrhcea,  «&c. 

109.   Cascarilla  and  Squills. 

R.  Tincture  Scillie,  fl.  drs.  iss — ij  ;  Acidi  Sulphuric!  Aromatici,  fl.  drm.  j  ; 
Liquoris  Morphiie  Hydrochloratis,  min.  xxx  ;  Infusi  CascarilliB,  ad  fl.  oz.  viij.  Mix. 
One-sixth  part  three  times  a  day. 

In  chronic  bronchitis  with  profuse  expectoration. 

110.  Alum  and  Syrup  of  Red  Poppy. 

R.  Aluminis  Exsiccati,  gr.  16:  Syrupi  Khoeados,  fl.  drs.  iij  ;  Aquse,  ad  fl.  oz.  ij. 
Mix.     One  teaspoonful  every  two  or  three  hours. 

In  the  catarrh  of  infants,  where  the  secretion  from  the  bronchial  tubes  is  excessive. 

111.   Oxide  of  Zinc. 

R.  Zinc!  Oxidi,  gr.  12;  Extract!  Conii,  vel  Hyoscyami,  gr.  18.  Make  a  mass, 
divide  into  six  pills,  and  order  one  to  be  taken  every  night  at  bedtime. 

For  the  relief  of  night-sweats  in  phthisis  and  other  exhausting  diseases,  there  arc 
few  remedies  more  serviceable  than  the  foregoing. 

R.  Zinc!  Oxidi,  gr.  2;  Morphias  Hydrochloratis,  gr.  \;  Extract!  Anthemidis,  gr. 
3,     Make  a  pill,  to  be  taken  night  and  morning. 


308  APPENDIX    OF    FORMULA. 


112.    WJiite  Bismuth. 

R.   Bismnthi  Albi,  gr.  60  ;  Syrupi  Papaveris,  fl.  drs.  iv  ;  Mneilaginis  Tragaeanthse, 
fl.  oz.  iv  ;  Aquae,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  or  eight  hours. 
Useful  in  checking  the  diarrhcea  of  phthisis. 

R.  Bismuthi  Albi,  gr.  80;  Pulveris  Kino  cum  Opio,  gr.  30:  Tincturse  Cinna- 
momi,  fl.  drs.  iij  ;  Mucilaginis  Tragacanth.-e,  fl.  oz.  ij  ;  Aquje,  ad  fl.  oz.  r].  Mix. 
One-sixth  part  every  four  hours. 

R.  Bismuthi  Albi,  gr.  10;  Pulveris  Ipeeacuanhse  cum  Opio,  gr.  5.  Make  a 
powder,  to  be  taken  every  night  at  bedtime. 

As  a  sedative  and  astringent  in  the  diarrhcea  of  phthisis.     See  F.  65. 

113.  Agtriyigent  Enemata. 

R.  Olei  Terebinthinse,  min.  xxx ;  Tincture  Kino,  fl.  drs.  ij  ;  Extracti  Opii 
Liquidi,  min.  xxv  ;   Mucilaginis  Amyli,  fl.  oz.  ij.     Make  an  enema. 

To  check  the  purging  in  typhoid  fever.  It  may  be  employed  twice  or  thrice  in 
the  twenty-four  hours,  if  necessary. 

R.  Bismuthi  Albi,  gr.  20;  Tincturre  Catechu,  fl.  drm.  j;  Liquoris  Morphiae 
Hydrochloratis,  min.  xxx  ;  Mucilaginis  Amyli,  fl.  oz.  ij.     Mix. 

To  check  the  purging  of  phthisis,  fever,  &c.  It  may  be  administered  every  twelve 
hours. 

114.  CJdoroform,  Opium,  and  Castor  Oil. 

R.  Chloroformi,  min.  vj — xij  ;  Tincturse  Camphorse  cum  Opio,  fl.  drs.  ij  ;  Olei 
Ricini,  fl.  drs.  iij  ;  Mucilaginis  Tragacanthae,  fl.  drs.  iij.  Make  a  draught,  to  be 
taken  immediately. 

In  choleraic  diarrhoea. 

115.  Alum  and  Sulphuric  Acid. 

R.  Alurainis  Exsiccati,  gr.  60;  Syrupi  Ehoeados,  fl.  drs.  vj  ;  Infusi  Eosse  Acidi,  ad 
fl.  oz.  viij.     Mix.     Two  tablespoonfuls  every  six  hours. 
In  passive  hemorrnage.     Also  in  some  cases  of  lead  colic. 

116.  Ammonia  Iron-Alum. 

R.  Eerri  Ammonio-Sulpbatis,  gr.  30 — CO;  Aquae  Destillatae,  fl.  oz.  viij.  Mix. 
One-sixth  part  every  six  or  eight  hours. 

An  excellent  astringent  in  some  forms  of  haematemesis,  haemotpysis,  &c. 

117.  Lead  and  Acetic  Acid. 

R.  Pilulae  Plumbi  cum  Opio,  gr.  4.  To  be  taken  every  two  or  three  hours,  with 
the  following  draught:  R.  Acidi  Acetici  Diluti,  fl.  drs.  ij  ;  Aqua?  Cinnamomi,  fl. 
drs.  vj.     Mix. 

In  severe  haemoptysis.  The  acetate  of  lead  is  inferior  to  gallic  acid  as  an  astringent, 
unless  given  in  larger  doses  than  are  commonly  employed.  According  to  Dr.  C.  K. 
Irwin,  this  lead  salt  may  be  prescribed  in  60,  120,  or  180  gr.  doses,  with  great  advan- 
tage, in  cases  of  uterine  hemorrhage  requiring  prompt  suppression. 

118.   Cold,  as  a  Local  Astringent. 

The  best  and  cheapest  freezing  mixture  is  made  with  ice  and  common  salt  in 
equal  parts.     Any  of  the  following,  however,  will  prove  useful : 

MIXTURES.  PARTS.  THERM.  SINKS. 

Hydrochlorate  of  Ammonia,     ....     5  ) 

Nitre, 5  I  From  50°  to  10° 

"Water, 10  J 

^^^^^^oiAmmoT^\^, J  |  pr^m  50°  to  4° 

Common  Salt, 1/ 

Snow  or  Ice, 12  ) 

Common  Salt, 5  ^  From  18°  to  —25° 

Nitrate  of  Ammonia, 5  J 


BATHS.  309 


VII.  BATHS. 

119.  Temperature  of  Simple  Baths, 

B\TH.  WATER.  VAPOR,  AIR. 

The  Cold,    .     .     33°  to    65°  F. 
"     Cool,    .     .     65°  to    75° 
*'     Tcunperate,  75°  to    85° 

"  Tepid,  .  85°  to  92°  ...  .  90°  to  100°  .  .  .  .  96°  to  106° 
"  Warm,  .  92°  to  98°  ...  .  100°  to  115°  ....  106°  to  12i)<» 
"     Hot,     .     .     98°  to  112°     .     .     .     .115°tol4U°     .     .     .     .120°  to  170° 

120.  Nitro-HydrocMoric  Acid  Baths, 

R.  Acidi  Nitrici,  fl.  oz.  iss ;  Acidi  Hydrochlorici,  fl.  oz.  j — iij ;  Aquae  Calidse, 
Cxxx.  Mix.  To  be  prepared  in  a  wooden  bath.  The  patient  should  remain  in  it  for 
from  ten  to  twenty  minutes. 

Useful  in  cases  where  the  liver  is  inactive, — as  in  invalids  from  tropical  climates. 

R.  Acidi  Nitrici,  fl.  drs,  iv;  Acidi  Hydrochlorici,  fl.  oz.  j  ;  Aquae  Calidse,  Civ. 
Mix,  for  a  footbath. 

In  dyspepsia,  with  derangement  of  the  liver  and  constipation.  To  be  used  in  a 
wooden  or  earthenware  vessel. 

121.  Alkaline  Bath. 

R.  Sodae  Carbonatis,  lb.  1 ;  Aquae  Ferventis,  Cxxx.     Mix. 

In  the  lithic  acid  diathesis,  chronic  squamous  diseases  of  the  skin,  chronic  rheu- 
matism, &c. 

122.    Conium  and  Starch  Bath. 

R.  Extract!  Conii,  gr.  120;  Pulveris  Amyli,  lb.  1;  Aquae  Ferventis,  Cxxx.    Mix, 
for  a  bath. 
In  certain  skin  diseases,  attended  with  great  irritability. 

123.    Creasote  Bath. 

R.  Creasoti,  fl.  drs.  ij  ;  Glycerini,  fl.  oz.  ij  ;  Aquae  Ferventis,  Cxxx.     Mix. 
In  squamous  diseases  of  the  skin. 

124.    Iodine  Bath. 

R.  lodinii,  gr,  60;  Potassii  lodidi,  oz.  ^;  Liquoris  Potassae,  fl.  oz.  ij  ;  Aquae  Cali- 
dae,  Cxxx.     Mix, 

In  scrofula,  chronic  rheumatism,  secondary  syphilis,  and  certain  skin  diseases. 

125.  Sulphur  Baths. 

R.  Potassae  Sulphuratffi,  oz.  4;   Aquje  Calida^,  Cxxx.     Mix. 
Useful  in  scabies,  lead  colic,  paralysis  from  lead,  »!cc. 

R.  Potassae  Sulphuratae,  oz.  4;  Sodae  Hyposulphitaj,  oz.  1;  Acidi  Sulphurici,  fl. 
drm.  j  ;  Aquae  Calidae,  Cxxx,     Mix. 

126.  Iroti,  or  Oak  Bark,  Baths. 

R.  Ferri  Sulphatis,  oz.  J;  Aquae,  Civ.     Mix. 
Especially  useful  for  strumous  and  rickety  children, 

R.  Quercfis  Contuse,  lb,  1;  Aquae  Calidae,  Oij,  Mix.  Boil  for  half  an  hour,  and 
add  the  strained  decoction  to  three  gallons  of  warm  or  tepid  water.  To  be  used  every 
morning. 

For  delicate  children,  &c. 


310  APPENDIX    OF   FORMULA. 

127.  Salt-water  Baths. 

B.  Salis  Marini  (vnlgo,  "Bay-salt"),  lb.  ^;  Aquie  Tepid«,  Civ.  Mix.  Make 
a  sponge-bath,  to  be  used  every  morning. 

In  general  debility,  chronic  rheumatism,  &c.  The  surface  of  the  body  should  be 
thoroughly  rubbed  with  a  flesh-brush  and  coarse  towels. 

K.  Salis  Marini,  lb.  2;  Magnesise  Sulphatis,  oz.  8;  Potassii  lodidi,  gr.  120;  Li- 
quoris  Calcis  Chloratse,  fl.  oz.  iss ;  Aquaj,  Cxxx.     Mix. 

128.  Arsenical  Bath. 

R.  Sodffi  Carbonatis,  oz.  4;  Sodas  Arscniatis,  gr.  20;  Aquse  Calidse,  Cxxx.     Mix, 
In  rheumatoid  arthritis,  skin  diseases,  &c. 

129.  Borax  Bath. 

R.  Boracis,  oz.  4;  Glycerini,  fl.  oz.  iij  ;  Aquje  Calidje,  Cxxx.     Mix, 
In  some  squamous  and  other  irritable  diseases  of  the  skin, 

130.   The  Turkish  Bath. 

The  general  effect  of  a  hot  air  bath  is  to  increase  the  force  and  rapidity  of  the  cir- 
culation, and  to  induce  free  perspiration  ;  but  if  too  hot  or  too  )irolonged  the  determi- 
nation of  blood  to  the  skin  and  lungs  becomes  so  great,  that  the  brain  suffers.  There 
is  then  consequently  a  lowering  of  the  circulation,  with  depressed  nervous  power. 
A  temperature  varying  from  120°  to  1(56°  will  usually  suiBce :  while  if  the  perspira- 
tion is  etflcient  and  continuous,  and  the  sensation  agreeable,  the  patient  may  remain 
in  the  calidarium  for  from  forty  to  sixty  minutes. — The  bath  is  usejid  in  removing 
local  congestions,  in  clearing  the  pores  and  in  inducing  a  healthy  condition  of  the 
skin  and  mucous  membranes,  in  eliminating  noxious  matters  from  the  blood,  and  in 
imparting  a  sense  of  elasticity  and  vigor  to  the  system.  It  is  injurious  when  there  is 
any  obstruction  to  the  circulation,  or  when  the  heart  or  vessels  are  aft'ected  with 
fatty  degeneration,  or  when  there  are  any  symptoms  of  disease  of  the  nervous  centres, 
or  when  there  is  a  tendency  to  vertigo  or  syncope,  and  in  advanced  life.  Women 
who  are  pregnant,  or  who  are  menstruating,  ought  not  to  have  recourse  to  it. 

131,  Mercurial  Vapor  Baths. 

The  patient  is  seated  on  a  chair,  and  covered  with  an  oil-cloth  lined  with  flannel, 
which  is  supported  by  a  proper  framework.  Under  the  chair  are  placed  a  copper  bath, 
containing  water,  and  a  metallic  plate  on  which  is  put  from  sixty  to  one  hundred 
and  eighty  grains  of  the  bisulphuret  of  mercury,  or  the  same  quantity  of  the  gray 
oxide,  or  the  red  oxide  of  this  metal.  In  syphilitic  atl'ections  of  the  skin,  testes  and 
bones,  from  five  to  thirty  grains  of  the  green  iodide  of  mercury  may  be  employed  ; 
or  a  mixture  of  twenty  grains  of  the  green  iodide  with  ninety  grains  of  the  bisul- 
]ihuret  often  proves  efficacious.  Under  the  bath  and  plate,  spirit-lamps  are  lighted. 
The  patient  is  thus  exposed  to  the  influence  of  three  agents — heated  air,  steam,  and 
the  vapor  of  mercury.  At  the  end  of  five  to  ten  minutes  perspiration  commences, 
which  becomes  excessive  in  ten  or  fifteen  minutes  longer.  The  lamps  are  now  to  be 
extinguished;  and  when  the  patient  has  become  moderately  cool  he  is  to  be  rubbed 
dry.  He  should  then  drink  a  cup  of  warm  decoction  of  guaiacum  or  sarsaparilla, 
and  repose  for  a  short  time. — Langston  Parkek.  In  constitutional  syphilis  when 
mercury  is  indicated.  This  method  of  introducing  mercury  into  the  system  may  also 
be  adopted  with  benefit  in  other  diseases,  in  place  of  administering  the  metal  by  the 
mouth. 

Mr.  Hknry  Lke's  mode  of  proceeding  is  more  simple,  and  is  the  one  which  the 
author  has  frequently  adopted  with  great  success.  A  convenient  apparatus  is  used, 
made  by  most  instrument  makers,  consisting  of  a  kind  of  tin  ease,  containing  a  spirit- 
lamp.  In  the  centre,  over  the  flame,  is  a  snuill  tin  plate,  upon  which  from  fifteen  to 
thirty  grains  of  calomel  are  placed ;  while  around  this  is  a  sort  of  saucer  filled  with  boil- 
ing water.  The  lamp  having  been  lighted,  the  apparatus  is  placed  under  a  common 
cane-bottomed  chair,  upon  which  the  patient  sits.  He  is  then  enveloped,  chair  and 
all,  in  one  or  more  large  blankets;  and  so  he  remains,  well  covered  up,  for  about 
twenty  minutes,  when  the  water  and  mercury  will  be  found  to  have  disappeared. 
About  five  minutes  afterwards  he  may  put  on  his  shirt  and  go  to  bed ;  but  it  is  better 
not  to  use  a  towel,  since  it  can  only  be  disadvantageous  to  wipe  oti"  the  calomel  depos- 
ited on  the  skin. 


BATHS.  311 


132.  Gelatine  Bath. 

Take  of  Gelatine,  or  Common  Glue,  lb.  1  ;  dissolve  in  a  little  boiling  water,  and 
then  add  twenty  gallons  of  hot  water  to  form  a  hath. 
In  eczema  and  other  irritable  cutaneous  atfections. 

133.  Mustard  Foot  Bath. 

R.  Pulveris  Sinapis,  oz.  2 — 4;  Aquae  Calidse,  Civ.     Mix,  for  a  foot  bath. 
In  congestions  of  the  head  and  chest,  in  some  cases  of  amenorrhcca,  &c. 

134.   Cold  Affusion. 

The  patient  is  seated  in  an  empty  bath,  and  from  four  to  six  buckets  of  cold  water 
(about  40°  F.)  are  poured  over  his  head  and  chest  from  a  height  of  two  or  more  feet. 
He  is  then  quickly  dried  and  replaced  in  bed.  The  colder  the  water  and  the  greater 
the  height  from  which  it  is  poured,  the  more  stimulating  the  effect.  Aliusion,  as 
thus  practised  by  Dr.  Carrie,  proved  very  valuable  in  the  treatment  of  typhus.  It 
may  be  resorted  to  when  the  temperature  of  the  body  is  permanently  above  its  nor- 
mal (about  98.4°  F.)  standard,  when  there  is  no  feeling  of  chilliness,  when  the  body 
is  not  wholly  bathed  in  sweat,  when  there  is  not  much  irritability  of  the  nervous 
system,  and  when  there  is  great  stupor.  The  etiect  is  to  lower  the  temperature,  to 
lessen  the  frequency  of  the  pulse  and  respiration,  to  render  the  tongue  njoist  and 
soft,  to  diminish  or  remove  the  stupor,  to  procure  sleep,  and  sometimes  to  produce  a 
critical  perspiration.     It  may  be  used  every  twenty-four  hours  if  necessary. 

When  it  is  desirable  to  apply  a  douehe-bath  to  one  or  more  of  the  joints,  it  is  only 
necessary  to  affix  two  or  three  yards  of  large-sized  India-rubber  tubing  to  the  tap  of 
a  cistern.  The  patient  must  sit  in  an  emjjty  bath,  into  which  the  water  may  fall  as 
it  jjlays  upon  the  limb. 

135.    The  Shalloiv  Bath. 

The  patient  sits  in  a  bath  some  six  feet  long,  with  a  depth  of  water  (temperature 
60°  to  80°  F.)  varying  from  eight  to  twelve  inches.  The  extremities  and  trunk  are 
well  rubbed  by  an  assistant,  while  water  is  gently  poured  over  the  head.  The  dura- 
tion of  the  bath  ought  to  vary  from  live  minutes  to  three-quarters  of  an  hour,  until 
the  temperature  of  the  body  is  lowered.  The  colder  the  water  and  the  shorter  the 
stay  in  it,  the  more  stimulating  and  less  sedative  will  be  the  effect.  This  bath  is  less 
exciting  than  the  cold  affusion,  and  is  chiefly  indicated  where  the  latter  would  be 
improper, — i.  e.,  where  there  is  much  nervous  irritability.  It  is  also  better  for 
women,  who  seldom  bear  the  cold  affusion. 

As  a  substitute  for  the  shallow  bath  the  drippinr/  sheet  is  sometimes  used.  The 
patient  stands  upright  in  an  empty  bath,  while  the  attendant,  placed  at  his  back, 
suddenly  envelops  him  in  a  sheet  dipped  into  water.  The  surface  of  the  body  is 
quickly  rubbed  by  the  servant's  flat  hands  for  some  three  minutes,  until  the  batlier 
is  in  a  glow;  when  a  dry  sheet  is  quickly  substituted  for  the  wet  one,  and  the  rub- 
bing continued.     The  whole  process  should  be  over  in  five  or  six  minutes. 

136.    Wet-sheet  Packing,  S^c. 

The  patient  is  closely  enveloped  in  a  sheet  which  has  been  dipped  in  cold  or  tepid 
water  and  well  wrung  out.  He  is  then  carefully  wrapped  in  a  blanket,  covered  with 
three  or  more  blankets,  and  a  down  coverlet  is  tucked  over  all.  He  should  remain 
thus  for  30,  45,  or  GO  minutes,  lying  on  his  side,  or  in  a  semi-recumbent  position  ; 
the  duration  being  timed  by  the  sedative  effect  produced.  The  sweating  is  not  gener- 
ally excessive.  But  the  water,  urea  and  chloride  of  sodium  of  the  urine  are  slightly 
increased;  this  increase  being  considerable  when  the  sheet  is  continued  forfou'r 
hours.  At  the  conclusion  the  shallow  bath  may  be  used  for  two  or  three  minutes, 
as  a  tonic. 

A  blanket-bath  affords  an  easy  means  of  inducing  sweating.  A  blanket  is  wrung 
out  of  hot  water,  and  wrapped  round  the  patient.  lie  is  to  be  packed  in  three  or  four 
dry  blankets,  and  allow^ed  to  repose  for  thirty  minutes.  The  surface  of  the  body  should 
then  be  well-rubbed  with  warm  towels,  and  the  patient  made  comfortable  in  bed. 

The  wet-compress  consists  merely  of  a  roll  of  flannel  or  calico,  dipped  in  cold  water 
and  wrung  out,  and  then  applied  around  the  scat  of  pain.  Over  this  a  piece  of  water- 
proof cloth  is  to  be  worn. 


312  APPENDIX    OF    FORxMUL^. 


137.    Tlie  Warm  Bath  as  a  Cooling  Agent. 

The  warm  bath  at  a  temperature  of  95°  F.  must  prove  a  cooling  agent  to  the  body 
of  a  fever  patient  at  100°  or  105°  F.  The  immersion  shoukl  continue  from  fifteen 
minutes  to  an  hour  or  longer.  Its  sedative  eflects  render  it  valuable  where  the  nerv- 
ous system  is  irritable. 

In  cases  of  delirium  tremens  with  high  fever,  cold  superfusion  may  be  used  while 
the  patient  is  held  in  the  warm  bath.  From  ten  to  thirty  buckets  of  cold  water  are 
to  be  poured  slowly  over  the  head ;  hot  water  being  continually  added  to  the  bath  to 
maintain  its  heat  at  95°  F.     This  treatment  generally  produces  sound  sleep. 

138.  Acid  Sponging. 

One  part  of  vinegar  is  to  be  added  to  two  or  three  of  cold  water,  and  the  body  well 
sponged  with  the  mixture.  Simple  tepid  water  may  sometimes  be  advantageously 
used.  The  patient  being  weak  and  unable  to  move,  the  sponging  must  be  done  by 
degrees :  i.  e.,  the  arms,  chest,  back,  and  legs  are  to  be  rapidly  washed  and  dried. 

In  many  cases  of  fever,  inflammation,  scarlatina,  &c. 


VIII.  CATHARTICS  AND  ANTHELMINTICS. 

139.   The  Common  Black  Draught. 

R.  Magnesias  Sulphatis,  gr.  120;  Mannae,  gr.  160;  Tincturae  Sennse,  fl.  drs.  ij  ; 
Infusi  Sennaj,  ad  fl.  oz.  iss.     Make  a  draught,  to  be  taken  early  in  the  morning. 

140.   Calomel,  Jalap,  and  Epsom  Salts. 

R.  Calomelanos,  gr.  5;  Pulveris  Jalaps,  gr.  15.  Make  a  powder,  to  be  taken 
immediately  ;  with  the  following  draught  three  hours  afterwards  : 

R.  Magnesiae  Sulphatis,  gr.  120;  Mannae,  gr.  60;  Tincturae  Jalapae,  fl.  drs.  ij  ; 
Aquae  Carui,  ad  fl.  oz.  iss.     Mix. 

A  good  active  purgative  in  head  afl^ections,  «S:c.,  as  well  as  at  the  commencement  of 
■many  acute  diseases. 

141.   Tlie  White  Mixture  of  Hospitals. 

R.  Magnesiae  Sulphatis,  oz.  IJ;  Magnesiae  Carbonatis,  gr.  120;  Aquae  Menthse 
Piperita,  fl.  oz.  viij.  Mix.  The  addition  of  two  fluid  drachms  of  Colchicum  wine  is 
sometimes  advantageous.     One-sixth  part  early  every  morning. 

142.  Epsom  Salts  and  Sulphuric  Acid. 

R.  Magnesiae  Sulphatis,  oz.  2;  Acidi  Sulphuric!  Diluti,  fl.  drs.  iss;  Tincturae 
Hyoscyami,  fl.  drs.  iij  ;  Infusi  Quassiae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  two  or 
three  times  a  day. 

In  painter's  colic,  copper  colic,  &c. 

R.  Magnesiae  Sulphatis,  oz.  ^;  Infusi  Kosae  Acidi,  fl.  oz.  ij.  Make  a  draught,  to 
■be  taken  early  in  the  morning. 

In  mild  febrile  att'ections  with  constipation. 

143.   Crlaubers  Salts  and  Sulphuric  Acid. 

R.  Sodae  Sulphatis,  gr.  120;  Ferri  Sulphatis,  gr.  3;  Acidi  Sulphuric!  Diluti, 
min.  XV  ;  Tincturae  Hyoscyami,  min.  xx  ;  Infusi  Calumbie,  fl.  oz.  ij.  Make  a  draught 
to  be  taken  the  first  thing  in  the  morning. 

In  obstinate  constipation  with  debilit}'. 

R.  Sodie  Sulphatis,  gr.  240;  Acidi  Sulphurici  Diluti,  fl.  drm.j  ;  Infusi  Gentianse 
•Compositi,  fl.  oz.  vj.  Mix.  Three  tablespoonfuls  to  be  taken  daily  after  luncheon 
or  dinner. 

In  habitual  constipation  with  flatulence. 


CATHARTICS    AND   ANTHELMINTICS.  313 


144.   Crlauhers  Salts  and  Taraxacum. 

R.  Sodae  Sulphatis,  gr.   120;  Succi  Taraxaci,   fl.   drs.   iss ;  Decocti   Taraxaci,   fl. 
oz.  ij.     Make  a  draught,  to  be  taken  every  morning  before  breakfast. 
In  constipation  witli  deficient  secretion  of  bile.     iSee  F.  148. 

145.  Aloes,  Senna,  and  Jalap. 

R  Tinctura;  Sennae,  Tinctura3  Jalapse,  aa  fl.  drs.  ij  ;  Infusi  Sennaj,  fl.  oz.  ij  ;  De- 
cocti Aloes  Compositi,  fl.  oz.  vss.  Mix.  Two  tablespoonfuls  to  be  taken  night  and 
morning. 

146.  Rhubarb,  Gentian,  and  Senna. 

R.  TinctursB  Khei,  fl.  drs.  ij  ;  Infusi  Gentians  Compositi,  Infusi  Senna?,  aa  fl.  drs. 
vij.     Make  a  draught,  to  be  taken  every  morning  an  hour  before  breakfast. 
A  mild  aperient  in  gouty  dyspepsia. 

147.  Nitric  Acid,  Senna,  and  Taraxacum. 

R.  Acidi  Nitrici  Diluti,  fl.  drs.  iss;  Spiritus  ^theris  Nitrosi,  fl.  drs.  ij  ;  Succi 
Taraxaci,  fl.  oz.  iss;  Tincturse  Sennae,  fl.  oz.  iv  ;  Infusi  Gentianao  Compositi,  ad  fl. 
oz.  viij.     Mix.     One-sixth  part  twice  or  thrice  daily. 

In  dyspepsia  with  debility  and  constipation.  Also  in  passive  hepatic  congestion, 
in  amenorrhoea  with  a  loaded  liver,  &c. 

148.  Alkaline  Aperients. 

R.   Decocti  Aloes  Compositi,  Infusi  Gentianee  Compositi,  aa  fl.   oz.  iv  ;  Liquoris 
Potassie,  fl.  drs.  ij.     Mix.     One-sixth  part  early  every  morning. 
Useful  in  bilious  headache. 

R.  Sodae  Sulphatis,  oz.  1§;  Sodae  Phosphatis,  oz.  1  ;  Syrupi  Zingiberis,  fl.  drs.  vj  ; 
Aquae,  ad  fl.  oz.  viij.  Mix.  Three  large  tablespoonfuls  immediately  ;  the  dose  to  be 
rejjeated  after  two  hours,  unless  the  bowels  should  be  freely  acted  on. 

R.  Sodiie  Sulphatis,   Sulphuris  Praecipitati,  aa  oz.  \\.     Mix.     Label, — "  One  tea- 
spoonful  in  a  tumblerful  of  milk  and  water  early  in  the  morning." 
In  rheumatoid  artliritis,  chronic  rheumatism,  sciatica,  &c. 

149.  Pliosphate  of  Soda  and  Aloes. 

R.  Extracti  Rhei,  gr.  10;  Sod;c  Phosphatis,  gr.  60;  Decocti  Aloes  Compositi,  fl. 
drs.  vj  ;  Aqute  Menthte  Viridis,  ad  fl.  oz.  ij.  Make  a  draught,  to  be  taken  at  bed- 
time. 

In  some  forms  of  chronic  gout,  jaundice  from  gallstones,  &c. 

150.  Aloes,  Senna,  and  Epsom  Salts. 

R.  Vini  Aloes,  fl.  drs.  ij  ;  Infusi  Sennae,  fl.  drs.  xiv  ;  Magnosiie  Sulphatis,  oz.  ^. 
Mix.  Half  of  this  mixture  to  be  taken  about  7  o'clock  in  the  morning,  and  the 
remainder  two  hours  after  breakfast,  if  required. 

151.  Jalap  and  Senna. 

R.  Tincturae  Senna,  fl.  oz.  j  ;  Tincturae  Jalapa?,  fl.  drs.  ij  ;  Vini  Colchici,  fl.  drm.  j  ; 
Aqua-  Pimentae,  fl.  oz.  ij.  Mix.  Label, — "  Half  of  this  draught  immediately,  and 
the  remainder  in  six  hours,  if  necessary." 

R.  Pulveris  .Falapse  Compositi,  gr.  30;  Syrupi  Sennae,  fl.  drm.  j  ;  Aquaj  Camphoroe, 
fl   drs.  xj.     Make  a  draught,  to  be  taken  early  every  morning. 
In  dropsy. 

152.  Saline  Purgative. 

R.  Vini  Antimoniale,  fl.  drm.  j ;  Magnesiae  Sulphatis,  oz.  J;  Liquoris  Ammoniae 
Acetatis,  fl.  drs.  iv;  Syrupi  Papaveris,  fl.  drs.  vj  ;  Aquae  Camphors,  ad  fl.  oz.  viij. 
Mix.     One-eighth  part  two  or  three  times  in  the  twenty-four  hours. 

In  hepatic  congestion,  &c. 


314  APPENDIX    OF    FORMULA. 


153.  Sulphur  and  Magnesia. 

R.  Magnesiae  Carbonatis,  gr.  20;  Sulpburis  Pr;ecipitati,  gr.  25;  Sodse  Bicar- 
bonatis,  gr.  10 ;  Pulveris  Zingiberis,  gr.  3.  Make  a  powder,  to  be  taken  earlj-  in  the 
morning  in  a  tumblerful  of  milk. 

A  valuable  aperient  for  delicate  females  subject  to  rheumatism.  Also  in  some  skin 
diseases. 

154.  Steel  and  Aloes. 

'    R.  Ferri  Sulphatis   Granulatse,  gr.  2;    Pilulse  Aloes  et  Myrrh se,  gr.  3.     Make  a 
pill,  to  be  taken  thrice  daily  after  meals. 

In  amenorrhcea,  chlorosis,  hysteria  with  constipation  and  debility,  &c.    See  F.  421. 

155.  Pepsine  and  Aloes. 

R.  Pepsinse  Porci,  gr.  32;  Extracti  Aloes  Barbadensis,  gr.  8;  Glycerini,  sufficient 
to  make  a  mass.  Divide  into  eight  pills,  silver  them,  and  order  one  to  be  taken  every 
day  at  dinner. 

In  dyspepsia,  some  diseases  of  the  rectum,  certain  forms  of  suppressed  menstrua- 
tion, &c. 

156.  Aloes  and  Cralbanum. 

R.  Pilulas  Aloes  et  Myrrhte,  Pilulse  Assafcetidse  Compositse,  aa  gr.  5.  Make  two 
pills,  to  be  taken  night  and  morning. 

In  hysteria  with  attacks  of  flatulent  colic,  and  in  some  forms  of  amenorrhcea. 

157.  Ulaterium,  or  Wild  Cucumber. 

R.  Liquoris  Ammoniaj  Acetatis,  fl.  drm.  j  ;  Spiritfis  iEtheris  Nitrosi,  fl.  drs.  iv ; 
Elaterii,  gr.  1 ;  Syrupi  Zingiberis,  fl.  drs.  iij.  Mix.  Direct, — "One  small  teaspoonful 
in  a  wineglassful  of  water  every  two  hours,  until  the  bowels  are  freely  acted  on." 

In  the  early  stages  of  acute  di"opsy  with  albuminuria. 

R.  Elaterii,  gr.  1^;  Pulveris  Capsici,  gr.  9;  Calomelanos,  gr.  12;  Extracti  Hyos- 
cyami,  gr.  18.  Make  a  mass,  divide  into  twelve  pills,  and  order  two  to  be  taken  for 
a  dose. 

If  a  very  active  purgative  is  required,  the  quantity  of  elaterium  may  be  doubled. 
The  Capsicum  prevents  the  nausea  which  elaterium  often  produces. 

R.  Elaterii,  gr.  1 ;  Extracti  Gentianse,  gr.  12.  Divide  into  four  pills,  and  order 
one  to  be  taken  every  night. 

In  dropsical  efl'usions,  and  where  it  is  desirable  to  produce  copious  watery  stools. 

158.   Gamboge  and  Cralbanum. 

R.  Pilulse  Cambogise  Compositse,  Pilulse  Assafcetidse  Compositse,  aa  gr.  5.  Make 
two  pills,  to  be  taken  every  night  at  bedtime. 

A  good  drastic  hydragogue  cathartic,  acting  chiefly  upon  the  small  intestines. 

159.   Calomel  and  Jalap,  ^c. 

R.  Calomelanos,  gr.  2 — 3;  Pulveris  Scammonii  Corapositi,  gr.  4;  Pulveris  Aro- 
matici,  gr.  5.     Mix,  for  a  powder  to  be  taken  at  bedtime. 

A  valuable  purgative  in  the  cerebral  atfections  of  children  ;  also  in  cases  of  thread- 
worm. 

R.  Calomelanos,  gr.  2;  Extracti  Jalapa?,  gr.  8.     Make  into  two  pills,  and  order 
them  to  be  taken  at  bedtime. 
In  cerebral  atiections,  &c. 

R.  Calomelanos,  gr.  6;  Pulveris  Jalapse  Compositi,  gr.  20 — 40.  Make  a  powder, 
to  be  taken  every  night  at  bedtime. 

A  good  hydragogue  cathartic.  The  calomel  increases  the  effect  of  the  jalap  and 
acid  tartrate  of  potash  (cream  of  tartar). 

R.  Calomelanos,  gr.  2;  Pulveris  Rhei,  gr.  20;  Pulveris  Zingiberis,  gr.  2.  Mix. 
To  be  taken  as  a  bolus,  in  a  little  wafer  paper,  at  bedtime. 


CATHARTICS   AND   ANTHELMINTICS.  315 


160.  Podophyllum  Peltatum^  or  May-apple. 

R.  Podophylli  Resinne,  gr.  h;  Piilveris  Rhei,  gr.  5;  Extract!  Hyoscyami,  gr.  3. 
Make  two  jiill.*,  to  be  taken  every  night  at  bedtime. 

As  a  purgative  in  jaundice  from  suppression,  in  torpid  liver,  and  in  dropsy  from 
cardiac  or  renal  or  hepatic  disease.  Podophyllin  produces  copious  bilious  stools  ;  but 
is  rather  uncertain,  and  is  apt  to  gripe  unless  combined  with  henbane. 

R.  Podophylli  Resinse,  gr.  6  ;  Pulveris  Zingiberis,  gr.  20 ;  Extracti  Hyoscyami, 
gr.  24.  Make  a  mass,  divide  into  twelve  pills,  and  order  two  to  be  taken  every  other 
night  at  bedtime. 

As  a  drastic  purgative  in  dropsy.     See  F.  30. 

161.  Ammonia  and  Rliuharh. 

R.  Spiritfts  Ammonise  Aromatici,  fl.  drs.  iij  ;  Tincturse  Rhei,  fl.  drs.  iv ;  Infusi 
Rhei,  ad  fl.  oz.  vj.     Mix.     One-sixth  part  to  be  taken  night  and  morning. 

162.   Gentian,  Ether,  and  Rhubarb. 

R.  Tincturse  Rhei,  fl.  oz.  j  ;  Tincturse  Gentianae  Compositae,  fl.  drs.  iv ;  Spiritfis 
Ammoniie  Aromatici,  Spiritus  jSitheris,  aa  fl.  drs.  iij  ;  Aqua;  Piraentse,  fl.  oz.  iv. 
Mix.     Two  tablespoonfuls  to  be  taken  occasionally. 

In  cases  of  colic,  flatulence,  nausea,  or  languor,  where  a  warm  stomachic  aperient  is 
needed. 

163.  Hellebore  and  Colehicum. 

R.  Tinctursa  Hellebori  (Phar.  Lond.  1851),  min.  xxx;  Vini  Colchici,  min.  xxv ; 
Tincture  Rhei,  fl.  drs.  ij  ;  Aqure  Camphoraa,  ad  fl.  oz.  iss.  Make  a  draught,  to  be 
taken  occasionally  early  in  the  morning. 

Useful  in  gout,  chronic  rheumatism,  &c. 

164.   Castor  Oil. 

R.  Olei  Ricini,  fl.  drs.  ij — iv.  To  be  taken  occasionally  about  11  a.m.  The  taste  of 
castor  oil  is  entirely  destroyed  by  mixing  it  with  a  teacupful  of  well  salted  and  pep- 
pered beef-tea. 

R.  Mucilaginis  Tragacanthaa,  fl.  oz.  ij  ;  Aquae  Cinnamomi,  fl.  oz.  iij  ;  Olei  Ricini, 
fl.  drs.  xij  ;  Tincturre  Rhei,  Syrupi  Aurantii,  fui  fl.  drs.  vj  ;  Tincturaj  Opii,  min.  xxx. 
Mix.     One-eighth  part  every  three  hours. 

In  dysentery,  when  there  are  scybala  in  the  rectum.  Also  where  an  aperient  with 
a  sedative  is  indicated. 

165.  Rhubarb  and  3Iagnesia,  or  Soda. 

R.  Magnesias  Carbonatis,  gr.  120;  Pulveris  Rhei,  gr.  60  ;  Pulveris  Aromatici,  gr. 
40;  Aquaj  Menthte  Piperitae,  fl.  oz.  vj.  Mix.  Two  tablespoonfuls  to  be  taken  every 
morning. 

R.  Pulveris  Rhei,  Sodse  Bicarbonatis,  aa  gr.  20;  Infusi  Rhei,  fl.  oz.  1.     Make  a 
draught,  to  be  taken  early  in  the  morning  two  or  three  times  a  week. 
Por  gouty  and  rheumatic  subjects. 

The  oflicinal  Pttlvis  Rhei  CoMPosiTtrs,  in  doses  of  20  to  120  grains,  is  a  valuable 
mild  aperient  where  the  intestinal  becretions  are  deranged  or  diminished  in  quantity. 
It  is  commonly  known  as  Gregory's  powder. 

166.  Epsom  Salts  and  Sulphate  of  Iron. 

R.  Magnesiae  Sulphatis,  gr.  120;  Ferri  Sulphatis,  gr.  4;  Acidi  Sulphurici  Diluti, 
min.  XV  ;  Extracti  Quassia?,  gr.  20;  Aquce  Pimento,  fl.  oz.  iss.  Make  a  draught,  to 
be  taken  early  in  the  morning. 

In  constipation  with  general  debility. 


316  APPENDIX    OF    FORMULA. 


167.   Colocynth  and  Tartarated  Antimony/. 

R.  Pilulae  Colocynthidis  et  Hyoscyami,  gr.  56;   Antimonii  Tartarati,  gr.  4.     Di- 
vide into  12  pills,  and  order  one  to  be  taken  every  night  at  bedtime. 
A  valuable  purgative  in  the  cerebral  congestions  of  strong  subjects, 

168.   Croton  Oil. 

R.  Olci  Crotonis,  min.  j — ij  ;  Olei  Caryophili,  min.  ij ;  Micse  Panis,  sufficient  to 
make  a  pill.     To  be  taken  immediately,  and  repeated  in  two  hours  if  necessary. 

R.  Olei  Crotonis,  min.  ij  ;  Butyri  Cacao,  gr.  30.  Make  a  suppository.  To  be  in- 
troduced into  the  rectum  early  in  the  morning. 

R.  Olei  Crotonis,  min.  j — ij  ;  Pilula?  Colocynthidis  Composita?,  gr.  30;  Piluhe  As- 
safostidse  Compositae,  gr.  60.  Make  a  mass,  divide  into  eighteen  pills  and  order  three 
to  be  taken  every  night  at  bedtime. 

In  cases  of  sciatica,  obstinate  neuralgia,  &c.,  w^ith  constipation. 

169.  Seidlitz  Powder. 

R.  Sodpe  Bicarbonatis,  gr.  40;  Sodae  et  Potassse  Tartratis,  gr.  120.  Mix,  and  make 
an  etfervescing  draught  with  thirty-seven  grains  of  Tartaric  or  Citric  Acid  dissolved 
in  a  tumblerful  of  water. 

The  Effervescent  Citrate  of  Magnesia,  in  doses  of  a  couple  of  teaspoonfuls, 
in  a  small  tumblerful  of  water,  is  a  very  agreeable  and  mild  aperient. 

170.  Purified  Ox  Bile. 

R.  Ammonias  Carbonatis,  gr.  34;  Fellis  Bovini  Purificati,  gr.  36.  Make  a  mass, 
divide  into  twelve  pills,  silver  them,  and  order  one  to  be  taken  three  hours  after  each 
of  the  principal  meals. 

In  dyspepsia  with  nausea,  constipation,  and  a  deposit  of  urates  in  the  urine. 

R.  Pulveris  Rhei,  gr.  24;  Fellis  Bovini  Purificati,  gr.  20;  Olei  Carui,  min.  x ; 
Pilulfe  Assafoetidae  Compositse,  gr.  18.  Make  a  mass,  divide  into  twelve  pills,  and 
order  two  to  be  taken  every  night  two  hours  after  supper. 

To  prevent  an  accumulation  of  faeces,  when  the  large  intestines  are  torpid.  Also, 
where  there  is  a  deficiency  of  bile. 

R.  Pilulaj  Colocynthidis  et  Hyoscyami,  Fellis  Bovini  Purificati,  Extracti  Lupuli, 
aa  gr.  20.  Make  a  mass,  divide  into  twelve  pills,  silver  them,  and  order  one  to  be 
taken  every  day  three  houz*s  after  dinner. 

In  constipation  with  flatulence  and  imperfect  digestion  of  the  food. 

R.  Magnesise  Carbonatis,  gr.  30;  Tincturae  Jalapaa,  fl.  drs.  ij ;  Tincturae  Sennas, 
fl.  oz.  j  ;  Fellis  Bovini  Purificati,  gr.  30;  Aqua3  Camphorae,  ad  fl.  oz.  iv.  Mix,  and 
label, — "  Half  of  this  mixture  immediately,  and  the  remainder  in  three  hours  if 
necessary." 

A  valuable  purgative  when  the  rectum  is  blocked  up  by  hardened  faeces. 

Capsules  containing  pig's  bile,  evaporated  to  dryness,  have  been  prepared  accord- 
ing to  the  directions  of  Dr.  Harley.  Each  capsule  contains  five  grains  of  prepared 
bile, — equal  to  one  hundred  grains  of  liquid  bile  fresh  from  the  gall-bladder.  Two 
or  three  are  to  be  taken  for  a  dose,  about  two  hours  after  a  meal;  when  stomachal 
digestion  being  nearly  conij)leted,  the  chyme  is  ready  to  pass  into  the  duodenum. 
The  capsules  imbibe  moisture  in  the  stomach :  and  then  in  their  soft  swollen  condi- 
tion, generally  get  ruptured  as  they  pass  through  the  pylorus.  In  this  way  the  bile 
is  mingled  with  the  chyme  at  the  same  time  that  this  happens  in  the  healthy  organism. 

In  jaundice  from  long-continued  obstruction.  Also  in  some  forms  of  duodenal 
dyspepsia  arising  from  sedentary  habits. 

171.   Rhubarb,  Mercury,  and  Henbane. 

R.  Pilulae  Hydrargyri  [vel  Hydrargyri  cum  Creta),  Piluhe  Rhei  Compositae,  Ex- 
tracti Hyoscyami,  aa  gr.  20.  Mix,  divide  into  twelve  pills,  and  order  two  to  be 
taken  occasionally  at  bedtime. 

Where  a  stronger  })urgutive  is  required  the  compound  colocynth  may  be  substi- 
tuted for  the  compound  rhubarb  pill. 


CATHARTICS   AND   ANTHELMINTICS.  317 


172.  Sulphate  of  Manganese. 

R.  Manganesia?  Sulphatis,  gr.  180;   Vini  Colchici,  min.  xv;   Infusi  Senna?,  Tnfusi 
Gentianix^  Compositi,  Afi  fl.  oz.  j.     JVIake  a  draught,  to  be  taken  curly  in  the  morning. 
In  gouty  or  rheumatic  habits,  with  a  doticient  secretion  of  bile. 

173.    Colocynth  and  Assafaiida. 

R.  Pilulje  Colocynthidis  et  Hj'oscyami,  Pilula;  Assaffjetida?  Composita?,  aa  gr.  5. 
Mix  into  two  yiills.     To  be  taken  occasionally  at  bedtime. 

In  constipation  with  flatulence.     A  valuable  purgative  for  hypochondriasis. 

174.   Gamboge,  Aloes,  and  Blue  Pill. 

R.  Pilulffl  Cambogiae  Compositfe,  gr.  5;  Pilulse  Hydrargyri,  gr.  3.  Make  two 
jiills,  to  be  taken  night  and  morning. 

In  dropsy  from  cardiac  or  hepatic  disease,  where  a  drastic  purgative  is  required. 

175.  Extract  of  Nux  Vomica. 

R.  Extracti  Nucis  Vomicte,  gr.  3 ;  Pulveris  Ipecacuanhas,  gr.  6 ;  Pilulae  Rhei 
Composite,  vel  Pilula?  Aloes  et  AssafoetidaJ,  gr.  40.  Make  a  mass,  divide  into  twelve 
pills,  and  order  two  to  be  taken  every  alternate  night  at  bedtime. 

In  habitual  constipation  from  atony  of  the  coats  of  the  bowel,  with  deficient  secre- 
tion of  intestinal  mucus. 

R.  Extracti  Nucis  Vomicae,  gr.  2;  Extracti  Aloes  Barbadensis,  gr.  6;  Extracti 
Rhei,  gr.  20.     Mix,  and  divide  into  six  pills.     One  to  be  taken  every  day  at  dinner. 
In  some  diseases  of  the  rectum,  &c. 

R.  Extracti  Hyoscyami,  gr.  40;  Pilula?  Colocynthidis  Composita?,  gr.  20;  Ex- 
tracti Nucis  Vomica?,  gr.  3.  Mix,  and  divide  into  twelve  pills.  Two  to  be  taken 
every  night. 

In  habitual  constipation.  They  may  be  continued  for  about  ten  days.  See  F.  378, 
387,  and  409. 

176.  Rhubarb  and  Magnesia  for  Infants. 

R.  Pulveris  Rhei,  gr.  15:  Magnesiae  Carbonatis,  gr.  60;  Aquae  Anethi,  fl.  oz.  iss. 
Mix,  and  order  one  teaspoonful  to  be  taken  every  two  hours  until  the  bowels  are 
freely  acted  on. 

177.  Sulphate  of  Zinc. 

R.  Zinci  Sulphatis,  Extracti  Gentiana?,  iia  gr.  5.  Make  into  two  pills,  and  order 
them  to  be  taken  three  times  a  day. 

Recommended  by  Mr.  Baly,  in  habitual  constipation,  after  the  bowels  have  been 
cleared  out  with  a  purgative  of  calomel  and  colocynth.  The  pills  should  be  taken 
immediately  after  meals,  for  two  or  three  weeks. 

178.   Quinine  and  Rhubarb. 

R.  Quiniae  Sulphatis,  gr.  2;  Extracti  Lupuli,  gr.  5;  Pilulae  Rhei  Compositse,  gr. 
3.     Mix  into  two  pills,  and  order  them  to  be  taken  every  day  at  dinner. 
Useful  in  some  forms  of  dyspepsia. 

179.  Ipecacuan,  Rhubarb,  and  Oxide  of  Silver. 

R.  Pulveris  Ipecacuanha?,  gr.  1  ;  Pulveris  Rhei,  gr.  3 ;  Argenti  Oxidi,  gr.  1  ;  Con- 
fectionis  Rosse  Canina?,  suflicient  to  form  a  pill. 

A  good  dinner  pill  where  there  is  uneasiness  and  oppression  after  meals,  the  result 
of  slow  digestion. 

180.  Steel,  Glauber's  Salts,  ^c. 

R.  Eerri  Sulphatis  Granulata?,  gr.  10;  Sodae  Sulphatis,  Magnesia?  Sulphatis,  iia  oz. 
1;  Sodii  Chloridi,  gr.  120;  Aquae,  Oj.  Mix.  Four  tablcspoonfuls  in  a  tumblerful 
of  warm  water  early  in  the  morning. 

A  rough  imitation  of  the  Cheltenham  Waters.  Useful  in  debility  with  constipa- 
tion. 


318  APPENDIX    OF    FORMULA. 


181.  Steel,  Glauber  s  Salts,  and  Soda. 

R.  Sodse  Bicarbonatis.  gr.  60;  Sodii  Chloridi,  gr.  4;  Sodre  Sulphatis,  gr.  10;  Mag- 
nesifB  Sulphatis,  gr.  3  ;  Ferri  Sulphatis,  gr.  \ — 1 ;  Aquae,  Oj.  Mix.  By  adding  forty 
grains  of  Citric  Acid  an  effervescing  water  is  produced. 

A  rough  imitation  of  the  Vichy  Waters.     In  some  forms  of  chronic  gout,  &c. 

R.  Sodai  Sulphatis,  gr.  120—240;  SodfB  Carbonatis,  gr.  20;  Sodii  Chloridi,  gr.  15; 
Cretaj  Preparataj,  gr.  10;  Ferri  Carbonatis  Saccliaratte,  gr.  15.     Make  a  powder,  and 
direct  it  to  be  taken  early  in  the  morning  in  half  a  pint  of  water. 
.    An  imitation  of  the  Carlsbad  Waters. 

182.  JCamela,  as  an  Anthelmintic. 

R.  Pulveris  Kamelaj,  gr.  60 — 180,  vel  Tincturas  Kamelae,  fl.  drs.  ij  ;  Syrupi  Au- 
rantii,  fl.  drs.  ij  ;  Mucilaginis  Tragacanthfe,  fl.  oz.  iss ;  Aquse,  ad  fl.  oz.  iij.  Make  a 
draught,  to  be  taken  earlj'  in  the  morning.  A  purgative  should  be  administered  six 
hours  afterwards.  Kamela  is  an  orange-red  resinous  substance  found  adhering  to  the 
capsules  of  the  Rottlera  tinctoria,  and  is  imported  from  India. 

Strongly  recommended  in  tapeworm. 

183.    TurjMntine,  as  an  Anthelmintic. 

R.  Olei  Ricini,  fl.  drs.  iv  ;  Olei  Terebinthinse,  fl.  drs.  iij  ;  Mucilaginis  Tragacanthte, 
fl.  drs.  iv  ;  Syrupi  Zingiberis,  fl.  drm.j  ;  Aquse,  fl.  drs.  iv.  Make  a  draught,  to  be 
taken  early  in  the  morning. 

In  tapeworm,  &c. 

184.  Kousso,  as  an  Anthelmintic. 

R.  Cusso,  in  pulvere,  gr.  240;  Mellis  Depurati,  sufficient  to  make  an  electuary. 
Label, — "  Half  of  this  electuary  to  be  taken  early  in  the  morning,  and  the  remainder 
six  hours  afterwards." 

In  tapeworm. 

The  officinal  Infusum  Cusso  may  also  be  taken  in  the  same  way,  in  doses  of  fl. 
oz.  iv. 

185.  Santonin,  as  an  Anthelmintic. 

R.  Santonini,  gr.  2 — 6;  Sacchari  Lactis,  gr.  15.  Make  a  powder.  To  betaken 
early  in  the  morning,  suspended  in  a  tablespoonful  of  cream.  The  patient  ought  to 
have  fasted  for  twelve  hours  previously.  The  dose  may  be  repeated  for  eight  or  ten 
days,  if  necessary ;  and  its  exhibition  should  be  followed  at  the  end  of  six  hours  by 
the  administration  of  an  ounce  of  the  Compound  Decoction  of  Aloes. 

A  specific  for  the  ascaris  lumbricoides.  Less  useful  for  the  ttenia  solium  and 
oxjj^uris  vermicularis.  The  patient  should  be  warned  that  after  a  few  doses  the  sight 
sometimes  becomes  perverted,  so  that  objects  seem  to  acquire  a  blue  or  yellow  or  some 
other  color. 

186.  Pomegranate,  as  an  Anthelmintic. 

R.  Spiritus  ^theris,  fl.  drm.  ss — j  ;  Decocti  Granati  Radicis,  fl.  oz.  j — ij.  Make  a 
draught,  to  be  taken  every  three  hours  until  four  doses  have  been  used. 

R.  Granati  Radicis  Corticis,  gr.  180;  Pulveris  Sabadilla?,  gr.  6;  Pulveris  Aro- 
matici,  gr.  60.  Mix,  and  divide  into  six  powders.  One  to  be  taken  every  two  hours, 
■until  the  whole  is  consumed. 

More  active  than  the  preceding.    A  saline  purge  should  be  given  after  the  last  dose. 

187.  3fale  Fern,  as  an  Anthelmintic. 

R.  Extracti  Filicis  Liquidi,  fl.  drs.  j — ij  ;  Syrupi  Zingiberis,  fl.  drs.  ij  ;  Mucilaginis 
Tragacanthse,  fl.  oz.  j ;  Aquie,  ad  fl.  oz.  iv.  Make  a  draught,  to  be  taken  earlj'  in  the 
morning;  only  liquid  nourishment  having  been  allowed  the  previous  day.  Four  hours 
afterwards  a  purgative  dose  of  castor  oil  or  aloes  should  be  administered. 

Especially  useful  for  destroying  tapeworms. 


CAUSTICS  AND   COUNTER-IRRITANTS.  319 


188.  Simple  Enemata. 

R.  Sodii  Chloridi,  oz.  1;  Decocti  Hordei,  fl.  oz.  xij.     Mix,  to  form  an  Enema. 
In  simple  constipation,  to  destroy  oxyurides,  &c. 

R.  Olc'i  01iva>,  fl.  oz.  vj — viij.  To  be  warmed  and  then  injected  into  the  rectum. 
It  should  be  retained  f(jr  twelve  or  eighteen  hours. 

Very  useful  in  structural  disease  of  the  bowel,  impaction  of  hardened  fa;ces,  &c. 

R.  Olei  Olivaj,  fl.  drs.  xij ;  Magnesias  Sulphatis,  gr.  220;  Decocti  Hordei,  ad  fl.  oz. 
xij.     Mix,  for  an  Enema. 

R.  Saponis  Mollis,  oz.  1 ;  Aqusc  Calidte,  fl.  oz.  xij.     Mix,  for  an  Enema. 

189.   Castor  Oil  and  Rue  Enema. 

R.  Olei  Kutffi,  min.  vj  ;  Olei  Ricini,  fl.  oz.  j  ;  Tincturae  Assafcetida,  fl.  drs.  ij  ;  De- 
cocti Aven£e,  fl.  oz.  vij.     Mix. 

Exceedingly  useful  in  flatulent  colic. 

190.   Castor  Oil  and  Turpentine  Enema. 

R.  Olei  Ricini,  fl.  drs.  xij ;  Olei  Terebinthinse,  fl.  drs.  iv  ;  Tincturae  Assafcetidae,  fl. 
drs.  ij  ;  Decocti  A  vena?,  ad  fl.  oz.  xij.     Mix. 

In  obstinate  constipation.  It  should  be  thrown  up  into  the  bowel  by  means  of  a 
long  tube  like  that  of  the  stomach-pump. 

191.    Croton  Oil  Enema. 

R.   Olei  Crotonis,  min.  vj  ;  Olei  Ricini,   fl.  oz.  j  ;   Olei  Terebinthinae,  fl.  drs.  ij  ; 
Decocti  Hordei,  ad  fl.  oz.  vj.     Mix. 
In  obstinate  constipation.    It  should  be  retained  for  three  or  four  hours,  if  possible. 

192.  Steel  Enema. 

R.  Tincturae  Ferri  Perchloridi,  fl.  drs.  j — iij  ;  Infusi  Quassiae,  fl.  oz.  viij.     Mix. 
To  destroy  oxyurides.     It  has  often  seemed  advantageous  to  the  author  to  admin- 
ister a  dose  of  calomel  and  scammony  at  the  same  time. 

193.   Tobacco  Enema. 

R.  Tabaci  Communis,  gr.  15:  Aquae  Bullientis,  fl.  oz.  viij.     Mix. 
To  be  employed  cautiously  in  some  exceptional  cases  of  strangulated  hernia,  ob- 
stinate constipation,  &c. 

194.  Purgative  Electuaries. 

R.  Confectionis  Sennae,  Potassae  Tartratis  Acidfe,  Succi  Taraxaci,  aa  oz.  1.     Mix. 
One  teaspoonful,  to  be  taken  occasionally,  an  hour  before  breakfast. 
In  constipation  with  inactive  liver  or  hemorrhoids. 

R.  Confectionis  Piperis,  Syrupi  Sennae,  Confectionis  Sulphuris,  aa  oz.  1 ;  Pulveris 
Jalapae,  gr.  10.     Mix.     One  teaspoonful  every  morning. 
In  constipation  with  chronic  rheumatism. 

R.  Confectionis  Sennae,  Confectionis  Scammonii,  Syrupi  Zingiberis,  aaoz.  1  ;  Ferri 
Carbonatis  Saccharatae,  gr.  220.     Mix.     One  teaspoonful  early  every  morning. 
In  some  forms  of  constipation  and  want  of  tone. 


IX.  CAUSTICS  AND  COUNTER-IRRITANTS. 

195.  Acid  Solution  of  Nitrate  of  Mercury. 

R.  Liquoris  Hydrargyri  Nitratis  Acidi,  fl.  drs.  ij  ;  Pulveris  Tragacanths  Com- 
positi,  sufficient  to  make  a  mass. 


320  APPENDIX    OF    FORMULA. 

Instead  of  this  paste  it  is  sometimes  better  to  apply  the  caustic  fluid  itself,  in  cer- 
tain cases  of  cancer  or  lupus.  The  solution  may  also  be  carefully  used  to  sloughing 
ulcers,  boils,  small  najvi,  &c.  It  is  to  be  verj'  lightly  painted  on  by  means  of  a  glass 
brush,  or  a  glass  rod. 

196.   Chromic  Acid. 

R.  Acidi  Chromici,  gr.  60;   Aquse,  fl.  drs.  iv.     Mix. 
To  destroy  warts,  small  growths  of  epithelial  cancer,  &c. 

197.   Chloride  of  Zinc,  ^c. 

R.   Bromii  Chloridi,  Zinci  Chloridi,  Auri  Chloridi,  Antimonii  Chloridi,  of  each 
equal  })arts.     Mix  into  a  paste  of  sufficient  thickness  with  flour  or  powdered  liquorice. 
To  destroy  cancerous  growths.     Commonly  known  as  Landolfi's  paste. 

R.  Sanguinaria?  Canadensis,  oz.  J — 1;  Zinci  Chloridi,  oz.  ^ — 2;  Aqua;,  fl.  oz.  ij  ; 
Farinje,  sufficient  to  make  a  paste.     Mix. 

The  paste  thus  formed  should  have  the  consistence  of  treacle.  This  is  the  caustic 
which  was  employed  by  Dr.  Fell. 

R.  Zinci  Chloridi,  gr.  30 — 60;  Farinae,  gr.  120;  Aquae  Destillatie,  sufficient  to 
form  a  mass.     To  be  applied  over  the  diseased  surface. 

198.  Supersulphate  of  Zinc. 

Take  half  a  fluid  ounce  of  sulphuric  acid,  and  saturate  it  with  sulphate  of  zinc,  pre- 
viously dried  and  powdered.  Sir  J.  Y.  Simpson  recommends  that  this  caustic  should 
be  used  by  dipping  a  pen  in  it,  and  then  drawing  lines  across  the  tumor,  so  as  to  eat 
through  the  skin  in  a  few  minutes.  The  fissures  thus  made  are  to  be  filled  with  the 
paste;  renewing  the  scratching  and  caustic  every  day  or  two.  In  this  way,  five  or 
eight  days  may  suffice  for  the  removal  of  a  good-sized  tumor.  By  this  combination 
also  we  can  penetrate  deeply  without  hardening  the  parts,  and  without  fear  of  pro- 
ducing hemorrhage. 

This  is  a  very  valuable  caustic,  and  has  been  found  particularly  useful  by  the  author 
for  the  removal  of  cancerous  tumors  of  the  breast,  &c.  The  pain  which  it  produces 
will  be  best  mitigated  by  employing  the  subcutaneous  injection  of  morphia  (F.  314) 
at  each  application. 

199.  Arsenical  Mucilage. 

R.  Acidi  Arseniosi,  Pulveris  Acacise,  aa  oz.  1  ;  Aqune,  fl.  drs.  v.     Mix. 

Dr.  Marsden  speaks  highly  of  this  caustic  in  cjiithelioma.  The  afl'ected  part  is  to 
be  painted  over  with  it  night  and  morning ;  taking  care  rigorously  to  limit  the  appli- 
cation to  the  diseased  parts,  and  not  to  let  it  extend  over  more  than  one  superficial 
inch  at  a  time.  As  the  part  sloughs,  its  separation  is  to  be  aided  by  bread-and-water 
poultices ;  and  when  all  the  disease  has  been  got  rid  of  by  the  repeated  ap})lications 
of  the  mucilage,  a  carrot  poultice  is  to  be  applied  during  the  night,  and  a  weak  black- 
wash  (calomel  gr.  60  to  lime-water  Oj)  during  the  day  until  the  part  is  healed. 

200.   Lime  and  Arsenic  Powder. 

R.  Calcis  recentis,  oz.  ^  ;  Arsenici  Sulphureti  Flavi,  gr.  20;  Pulveris  Amyli,  gr. 
180.     Mix,  to  form  a  powder. 

To  be  used  very  cautiously  as  a  depilatory  powder. 

201.  Med  Oxide  of  3Iercury  Powder. 

R.  Hydrargyri  Oxidi  Kubri,  Aluminis,  aa  gr.  60.     Make  a  powder. 

To  be  sprinkled  over  exuberant  and  spongy  granulations. 

202.  Carbonate  of  Copper  Ointment. 

R.  Cupri  Carbonatis,  gr.  60;   Adipis  Preparati,  oz.  ^.     Mix,  to  form  an  ointment. 
Devkroie. — In  chronic  eczema  and  impetigo  of  the  scalp  where  stimulating  appli- 
cations are  required. 

203.  Dupu'i/tren  8  Arsenic  and  Caloinel  Powder. 

R.  Acidi  Arseniosi,  gr.  12 ;  Calomelanos,  oz.  1.     Mix. 
In  ulcerated  lupus.     Must  be  cautiously  used. 


DIAPHORETICS    AND    DIURETICS.  321 


204.  Vienna  Caustic. 

R.   Potassnc  Ilydratis,  Calcis,  fiu  oz.  1.     Mix  thoroughly. 

This  paste  is  dikitnd  witii  alcohol,  and  applied  with  a  spatula  over  a  small  surface. 
It  is  identical  with  the  Potassa  cum  calce  of  the  London  Pharmacopoeia. 

205.  Iodine  Paint. 

R.  lodinii,  gr.  40 — CO;   Potassi  lodidi,  gr.  30;  Spiritus  Vini  Eectificati,  fl.  oz.  j. 
Mix. 
To  be  applied  with  a  camel's- hair  pencil.     Very  useful  in  many  chronic  pains,  &c. 

R.  lodinii,  Potassi  lodidi,  aa  grs.  20;   Collodii,  fl.  oz.  j.     Mix. 

The  oflBcinal  Linimkntum  Iodi  may  also  be  used,  but  it  must  be  diluted  with  from 
three  to  six  parts  of  spirit  or  glycerine,  or  tincture  of  aconite. 

206.    Tartar  Emetic  Embrocation. 

R.  Antimonii  Tartarati,  gr.  40;  Aqua?  Eos.-e,  fl.  oz.  ij.  Mix,  and  then  add  Tinc- 
tur;e  Cantharidis,  fl.  oz.  j.     Make  an  embrocation. 

To  be  employed  if  the  Unguentum  antimonii  tartarati  (Phar.  Brit.)  fails  to  produce 
the  required  erudition. 

207.   Croton  Oil  Liniment. 

R.  Olei  Crotonis,  min.  xxx ;  Olei  Olivae,  fl.  drs.  ijss.     Mix,  for  a  liniment. 

To  produce  rubefaction  and  a  pustular  eruption,  where  counter-irritation  is  re- 
quired to  relieve  diseases  of  internal  organs.  The  ofiicinal  liniment  is  only  1  part  to 
7,  and  is  scarcely  strong  enough. 

208.  Blistering  and  Epispastic  Papers. 

These  papers  of  M.  Albespeyre  have  long  been  used  in  this  country  with  great 
advantage,  though  they  are  less  appreciated  than  in  France. 

They  consist — of  an  epispastic  paper  for  dressing  blisters;  a  dulcifying  paper  for 
issues,  causing  neither  smell  noc  pain ;  and  blisters  formed  of  an  adhesive  cloth  with- 
out a  plaster. 

The  Epispastic  Paper,  for  dressing  blisters,  is  prepared  of  four  degrees  of  strength, 
under  the  designation  of  No.  1  feeble,  No.  1,  No.  2,  and  No.  3.  No.  1  feeble  possesses 
the  least  strength,  and  is  suitable  as  a  dressing  for  persons  of  irritable  temperament, 
and  for  children.  No.  1  has  rather  more  salve  spread  upon  it,  and  is  adapted  for 
patients  whose  blisters  have  risen  well.  No.  2  is  employed  for  those  whose  blisters 
do  not  draw  sufliciently,  and  require  stimulating.  Whilst  No.  3  possesses  a  still 
stronger  power,  and  is  used  only  in  cases  where  the  blister  has  a  tendency  to  dry  up. 
They  all  maintain  an  abundant  discharge,  without  pain  or  heat;  prevent  the  forma- 
tion of  false  membranes ;  produce  no  irritation  of  the  urinary  passages ;  and  cause 
no  disagreeable  smell. 

The  blisters — applied  by  the  adhesive  black  side — readily  adhere  to  the  skin,  pro- 
ducing vesication  in  a  few  hours  (twelve  at  the  furthest) ;  and,  if  necessary,  the  same 
piece  put  on  four  or  five  times  always  produces  the  blistering  eft'ect. 


X.  DIAPHORETICS  AND  DIURETICS. 

209.   Nitr^  and  Ipecacuan, 

R.  PotassfB  Nitratis,  gr.  60,  vel  Potassie  Citratis,  gr.  120;  Vini  Ipecacuanha?,  fl. 
drs.  iss  ;  Syrupi  Hemidesmi,  fl.  oz.  j  ;  Decocti  Hordei,  ad  Oj.  Mix.  One  teacui)ful 
to  be  taken  every  two  or  three  hours. 

In  severe  catarrh  with  sore  throat. 

21 


322  APPENDIX   OF   FORMULA. 


210.  Antimony  and  Opium. 

R.  Yini  Antimoniale,  fl.  drs.  j — ij  ;  Liquoris  Abimoniffi  Acetatis,  fl.  drs.  iv ;  Ex- 
tract! Opii  Liquidi,  min.  xxx  ;  Aquae  CamjDhoriB,  ad  fl.  oz.  vj.  Mix.  One-sixth  part 
three  times  a  day. 

Each  fluid  drachm  of  the  wine  contains  one-quarter  of  a  grain  of  antimony. 

211.   Citrate  of  Potash  and  Ammonia. 

R.  Potassje  Citratis,  gr.  120;  Liquoris  Ammonise  Acetatis,  fl.  drs.  iv ;  Spiritus 
Ammoniae  Aromatici,  fl.  drs.  iij  ;  Tincture  Aconiti,  min.  xx ;  Aquae,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  every  four  or  six  hours. 

In  pneumonia,  and  many  other  acute  inflammations.  Sometimes  it  is  preferable 
to  give  only  the  Solution  of  Acetate  of  Ammonia  diluted  with  water  (one  fluid  drachm 
to  two  ounces).    • 

211.  Ether  and  Ammonia. 

R.  Potassae  Nitratis,  gr.  30 — 60;  SpiritCis  ^theris  Nitrosi,  fl.  drs.  iij;  Liquoris 
Ammonite  Acetatis,  fl.  drs.  iv  ;  Aquae  Camphorae,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  or  four  times  a  day. 

In  the  early  stages  of  many  febrile  and  inflammatory  disorders. 

R.  Ammoniae  Carbonatis,  gr.  18 — 30  ;  Spiritus  Chloroformi,  fl.  drs.  vj  ;  Vini 
Colchici,  min.  xxx  ;  Liquoris  Ammonice  Acetatis,  fl.  drs.  iij — vj  ;  Mucilaginis  Traga- 
canthas,  fl.  oz.  iv ;  Aquae,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  four  hours. 

Valuable  in  some  forms  of  pneumonia,  &c. 

213.  Dover  8  Powder  and  Antimony,  ^-c. 

R.  Pulveris  Ipecacuanhae  cum  Opio,  gr.  5;  Antimonii  Tartarati,  gr.  \.  Mix,  and 
make  a  powder,  to  be  taken  every  six  hours. 

R.  Pulveris  Opii,  Pulveris  Ipecacuanhae,  aA  gr.  1 ;  Potassae  Nitratis,  gr.  8.  Make 
&  powder,  to  be  taken  every  night  at  bedtime. 

An  improvement  on  the  ordinary  Dover's  powder. 

214.  Senega  and  Guaiac. 

R.  Tincturae  Guaiaci  Ammoniatae,  fl.  drs.  iij — vj  ;  Mucilaginis  Tragacanthae,  fl. 
oz.  iij.  Mix  thoroughly  together,  and  then  add, — Infusi  Senegie,  ad  fl.  oz.  viij. 
Three  tablespoonfuls  to  be  taken  thrice  daily. 

Useful  in  the  latter  stages  of  bronchitis,  tonsillitis,  «S:c.  The  action  is  diaphoretic, 
diuretic,  stimulant,  and  expectorant. 

R.  Tincturre  Guaiaci  Ammoniatae,  fl.  drs.  ij  ;  Vitelli  Ovi,  1.  Beat  thoroughly 
together,  and  then  add, — Misturas  Amygdalae,  fl.  oz.  iv.  Direct,  one-half  to  be  taken 
twice  a  day. 

In  chronic  rheumatism. 

215.  Benzoate  of  Ammonia. 

R.  Ammoniae  Benzoatis,  gr.  60 — 120;  Syrupi  Hemidesmi,  fl.  oz.  j  ;  Aqua?,  ad  fl. 
oz.  viij.     Mix.     One-sixth  ])art  three  times  a  day. 

As  a  diuretic  in  dropsy  and  gout.  Also  in  catarrhal  inflammation  of  the  bladder 
with  alkaline  urine. 

216.  Ipecacuan  and  Syrup  of  Poppies. 

R.  AMni  Ipecacuanha',  fl.  drs.  ij  ;  Syrupi  Papaveris,  fl.  drs.  iij  ;  Mucilaginis  Traga- 
canthae, fl.  oz.  j  ;  Aquic,  ad  fl.  oz.  iij.  Mix.  One  teaspoonful  every  two  or  three 
hours. 

An  infantile  couirh  mixture. 


DIAPHORETICS   AND   DIURETICS.  323 


217.  Antimony  and  Ipecacuan, 

R.  Vini  Antimoniiilo,  fl.  drs.  iss ;  Vini  Ipccacuanhse,  fl.  clrs.  ij  ;  Syrupi  Rhcinados, 
fl.  drs.  iij ;  Liquoris  Ainmoniio  Acetatis,  fl.  drs.  ij  ;  Aqute,  ad  fl.  oz.  vj.  Mix.  A 
small  tablespooufiil  every  two  lidurs. 

A  depressing  mixture'for  children  two  or  three  years  of  age. 

218.  Ipecacuan  and  Syrup  of  Poppies. 

R.  Vini  Ipecacuanliie,  fl.  drs.  ij  ;  Syrupi  Papaveris,  fl.  drs.  iij  ;  Liquoris  Ammonije 
Acetatis,  fl.  drs.  ij  ;  iSpiritus  ^Etlieris  Nitrosi,  fl.  drm.  j  ;  Aquae,  ad  fl.  oz.  ij.  Mix. 
One  teaspoonful  every  two  or  three  hours. 

In  the  early  stage  of  infantile  fever,  severe  catarrh,  bronchitis,  and  pneumonia. 

219.  Squills,  Digitalis,  Broom,  ^c. 

R.  Potassiie  Acetatis,  gr.  120;  Syrupi  Scilla3,  fl.  drs.  vj  ;  Spiritus  yEtheris  Nitrosi, 
fl.  drs.  iij  ;  Tiacturte  Digitalis,  min.  xxx — fl.  drm.  j  ;  Succi  Scoparii,  fl.  drs.  vj  ; 
Aquie,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  or  eight  hours. 

As  a  diuretic  in  dropsy  dependent  upon  disease  of  the  heart,  liver,  or  peritoneum. 

R.  Tincturse  Scilla3,  fl.  drs.  ij  ;  Tincturae  Camphorse  cum  Opio,  fl.  drs.  iv;  Liquoris 
Ammonias  Acetatis,  fl.  drs.  iv  ;  Decocti  Scoparii,  ad  fl.  oz.  viij.  Mix.  One-sixth  part 
three  times  a  day. 

Diuretic  and  diaphoretic.  In  dropsies  unaccompanied  by  inflammation,  and  not 
due  to  renal  disease. 

R.  Spiritus  Juniperi,  fl.  drs.  ij  ;  Potass*  Tartratis  Acidae,  oz.  1;  Decocti  Scoparii, 
ad  fl.  oz.  xij.     Mix.     One-sixth  part  three  times  a  day. 
Diuretic  and  laxative. 

R.  Pulveris  Scillfe,  gr.  6  ;  Pulveris  Digitalis,  gr.  8 — 12;  Pilulae  Hydrargyri,  gr.  30 
Make  a  mass,  divide  into  twelve  pills,  and  order  one  to  be  taken  night  and  morning 
with  a  wineglassful  of  the  Decoctum  Scoparii.     See  F.  224. 

220.  Solution  of  Potash  and  Digitalis. 

R.  Liquoris  Potassaj,  fl.  drs.  j — ij  ;  Spiritus  ^Etheris  Nitrosi,  fl.  drs.  vj.;  Tincturse 
Croci,  fl.  drs.  iij  ;  Infusi  Digitalis,  fl.  drs.  xij  ;  Syrupi,  fl.  drs.  vj  ;  Aquie,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  three  times  a  day. 

A  valuable  diuretic  in  some  forms  of  cardiac  and  hepatic  dropsy. 

221.  Nitre,  Juniper,  and  Ether. 

R.  Potasspe  Nitratis,  gr.  60;  Spiritus  Juniperi,  fl.  drs.  j — ij  ;  Spiritus  ^Etheris 
Nitrosi,  fl.  drs.  iij  ;  Decocti  Chimaphilaj  (Phar.  Lond.  1851),  ad  fl.  oz.  viij.  Mix. 
One-sixth  part  every  six  hours. 

A  tonic  and  stimulating  diuretic.  In  scrofula,  atonic  dropsies,  catarrhal  inflam- 
mation of  the  bladder,  and  some  skin  diseases. 

222.  Buchu  and  Cream  of  Tartar. 

R.  Potassaj  Tartratis  Acidaj,  gr.  180;  Infusi  Bucco,  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

Diuretic  and  laxative.  In  irritable  conditions  of  the  bladder  owing  to  excess  of 
uric  acid  in  the  urine.  Also  in  chronic  rheumatism,  dropsy,  and  some  cutaneous 
diseases. 

223.  Buchu,  Borax,  and  Pareira. 

R.  Boracis,  gr.  40;  Tincturse  Bucco,  fl.  drs.  vj ;  Extracti  Pareira?,  oz.  \;  Decocti 
Pareirffi,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  or  eight  hours. 
In  chronic  catarrh  of  the  bladder,  calculous  aflections,  &c. 


324  APPENDIX    OF    FORMULA. 


224.  Digitalis,  Squills,  cj-c. 

R.  PotassEO  Citratis,  gr.  200;  Tincture  Scillaj,  fl.  drs.  ij  ;  Vini  Colchici,  fl.  drs. 
iss  ;  Liquoris  AmmoniiB  Acetatis,  fl.  drs.  ij  ;  Infusi  Digitalis,  fl.  oz.  iij  ;  Aqua3  Menthae 
Piperitas,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

Diuretic  and  sedative.     In  some  forms  of  dropsy  with  disease  of  the  mitral  valve. 

R.  Pulveris  Digitalis,  Pulveris  Scillix%  aa  gr.  12;  Extracti  Taraxaci,  gr.  86.  Make 
a  mass,  divide  into  twelve  pills,  and  order  one  to  be  taken  twice  a  day. 

Valuable  as  a  diuretic  in  mitral,  but  injurious  in  aortic  disease.     See  F.  219. 

225.    Urea. 

R.  Urefe,  gr.  5 — 15 ;  Syrupi  Aurantii,  fl.  drm.  j  ;  Aqua,  fl.  oz.  j.  Make  a  draught, 
to  be  taken  every  six  hours. 

Recommended  by  the  author  as  a  diuretic  in  dropsj^  due  to  cardiac  disease.  See 
Medical  Times  and'  Gazette,  8th  May,  1852. 

226.   Cantharides  ajid  Nitrous  Ether. 

R.  Tincturse  Cantharidis,  fl.  drs.  j — ij  ;  Spiritiis  ^theris  Nitrosi,  fl.  drs.  iij  ; 
Spiritus  Juniperi,  fl.  drs.  iv  ;  Syrupi  Zingiberis,  fl.  drs.  vj  ;  Aquae,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  three  times  a  day. 

May  be  cautiously  tried  in  some  cases  of  suppression  of  urine.  Also  in  some  skin 
diseases. 

227.   Taraxacum  and  Nitric  Acid. 

R.  Acidi  Nitrici  Diluti,  fl.  drm.  j  ;  Succi  Taraxaci,  fl.  drs.  vj  ;  Decocti  Taraxaci, 
ad  fl.  oz.  viij.     Mix.     One-sixth  ])art  three  times  a  day. 

Laxative,  alterative,  and  diuretic.  Especially  useful  in  disease  of  the  liver  unac- 
companied by  inflammation. 

228.   Cream  of  Tartar  and  Taraxacum. 

R.   Potassae  Tartratis  Acidae,  oz.  1  ;  Extracti  Taraxaci,  gr.  30;  Decocti  Taraxaci, 
fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  da^^ 
In  jaundice  independent  of  hepatitis  or  obstruction  of  the  duct  of  the  gall-bladder. 

229.   Oil  of  Juniper. 

R.  Olei  Jutiiperi,  min.  xx ;  Syrupi  Limonis,  fl.  drs.  vj  ;  Mucilaginis  Acaciao,  fl.  oz. 
iv  ;  Aquse,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  or  eight  hours. 

The  oil  of  juniper  has  not  only  a  diuretic  action,  but  it  is  also  a  diaphoretic  and  an 
emmenagogue  and  a  cathartic.  In  too  large  doses  it  may  cause  inflammation  of  the 
bladder. 

230.   Conium,  Digitalis,  and  Calomel. 

R.   Pulveris  Digitalis,  Calomelanos,  aa  gr.  5;  Extracti  Conii,  gr.  CO.      Make  a 
mass,  divide  into  fifteen  pills,  and  order  one  to  be  taken  three  times  a  day. 
As  a  sedative  and  diuretic  in  dropsy  from  cardiac  disease. 


XI.  EMETICS  AND  EXPECTORANTS. 

231.  Depressing  Emetics. 

R.  Antimonii  Tartarati,  gr.  1—2;  Vini  Ipecacuanha?,  fl.  drs.  ij  ;  Aqute,  ad  fl.  oz- 
iss.     Make  a  draught,  to  be  taken  immediately. 
Its  action  should  be  aided  by  the  free  administration  of  warm  water. 

R.  Antimonii  Tartarati,  gr.  1;  Pulveris  Ipecacuanhse,  gr.  20.     Make  a  powder. 
To  be  taken  in  honey  or  cream,  or  as  a  bolus  in  wafer  paper. 

R.  Vini  Ipecacuanhse,  fl.  oz.  j.    To  be  taken  when  it  is  desired  to  induce  vomiting. 
For  children  one  fluid  drachm,  in  sweetened  water,  will  generally  suflice. 


EMETICS   AND    EXPECTORANTS.  325 


232.  Stimulant  Emetics. 

R.  Pulveris  Sinapis,  oz.  \]  Aquae,  fl.  oz.  iij.     Make  a  draught.     To  be  taken  im- 
mediately. 
R.  Cupri  Sulphatis,  gr.  10;  Aquie,  fl.  oz.  iij.     Make  an  emetic  draught. 
R.  Ziuci  Sulphatis,  gr.  20 — 40;  Aqua3,  fl.  oz.  iij.     Mix. 

233.  A  Warm  Emetic. 

R.  Pulveris  Ipecacuanha},  Ammonia3  Carbonatis,  afi  gr.  20;  TincturiB  Lavandulae 
Composit;c,  fl'.  drm.  j  ;  Aqua%  fl.  oz.  ij.  Make  a  draught.  After  taking  it,  a  tumbler- 
ful of  infusion  of  Chamomile  Flowers  (Infusum  Anthemidis)  should  be  drunk. 

Suggested  by  a  formula  of  Dr.  Druitt's.  In  the  incipient  stages  of  fever,  erysipe- 
las, &c. 

234.   Tartar  Emetic  Mixture. 

R.  Antimonii  Tartarati,  gr.  2;  Syrupi  Khoeados,  Aqua?,  aa  fl.  drs.  iv.  _  Mix  and 
label, — "  One  teaspoonful  every  two  hours,  in  a  wineglassful  of  water,  until  there  is 
nausea." 

As  a  depressant  to  the  circulating  and  nervous  systems. 

235.  Ammonia  and  Senega. 

R.  Ammonia?  Carbonatis,  gr.  30;  Spiritus  iEtheris,  fl.  drs.  iij;  Tincturre  Scillse» 
fl.  drs.  iss  ;  Tinctura?  Camphorje  cum  Opio,  fl.  drs.  ij — iv  ;  Tincturto  Lavandula?  Cora- 
positie,  fl.  drs.  vj  ;  Infusi  Senegae,  ad  fl.  oz.  viij.  Mix.  Two  tablespoonfuls  every 
four  hours. 

In  the  chronic  bronchitis  of  old  people. 

R.  Spiritus  Ammonia?  Aromatici,  fl.  drs.  iv  ;  Spiritus  Chloroformi,  fl.  drs.  iij  ; 
Tinctura?  Aconiti,  min.  xxx  ;  Tincturaa  Senegse,  fl.  drs.  vj  ;  Aquse  Carnphora?,  ad  fl. 
oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

A  valuable  stimulating  expectorant  in  some  cases  of  bronchitis. 

R.  Ammonise  Carbonatis,  gr.  12;  Vini  Ipecacuanha,  min.  xl ;  Tincturse  Senegse, 
fl.  drs.  ij  ;  Syrupi  Rhceados,  fl.  drs.  iij ;  Aqua?,  ad  fl.  oz.  iij.  Mix.  One  dessertspoon- 
ful every  two  or  three  hours. 

An  excellent  stimulating  expectorant  for  young  children  recovering  from  croup. 
In  hooping-cough,  where  the  bronchi  are  loaded  with  mucus. 

236.  Squills,  Nitric  Acid,  and  Bark. 

R.  Syrupi  Scillie,  fl.  drs.  vj  ;  Acidi  Nitrici  Diluti,  fl.  drra.  j ;  Tinctura?  Hyos- 
cyami,  fl.  drs.  iij  ;  Spiritus  Chloroformi,  fl.  drs.  vj  ;  Infusi  Cinchonae  Flava?,  ad  fl.  oz. 
viij.     Mix.     One-sixth  part  twice  or  thrice  daily. 

In  chronic  catarrh  with  debility  and  restlessness. 

237.  Ammoniacum  and  Opium. 

R.  Tincture  Scillas,  fl.  drs.  iss;  Extracti  Opii  Liquidi,  min.  xx — xxx;  Syrupi 
Tolutani,  fl.  drs.  vj  ;  Misturse  Ammoniaci,  ad  fl.  oz.  vj.  Mix.  One-sixth  part  three 
times  a  day. 

A  sedative  and  expectorant  mixture  in  the  chronic  bronchitis  of  elderlj'  people. 

238.  Sarsaparilla  and  Squills. 

R.  Extracti  Sarsfe  Liquidi,  Syrupi  Scilhe,  aa  fl.  drs.  xij.  Mix,  and  label, — "One 
teaspoonful  in  a  teacupful  of  barley-water  frequently  during  the  day." 

An  agreeable  demulcent  and  expectorant  in  inflammation  of  the  mucous  mem- 
branes about  the  throat  and  air-passages. 

239.  Squills,  Ammonia,  and  MorpJiia. 

R.  Syrupi  Scillpe,  fl.  drs.  vj  ;  Spiritus  Ammonise  Aromatici,  fl.  drs.  iij  ;  Liquoris 
Morphia?  Hydrochloratis,  fl.  drm.  j  (equivalent  to  half  a  grain  of  the  salt) ;  Infusi 
Serpentaria^,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  twice  or  thrice  a  day. 

In  chronic  catarrh. 


326  APPENDIX   OF   FORMULA. 


240.  Antimony  and  Ether. 

R.  Yini  Antimoniale,  fl.  drs.  iss ;  Spiritus  Athens,  fl.  drs.  iij  ;  Muoilaginis  Trag- 
acanthit,  fl.  oz.  iij  ;  Aqiue,  ad  fl.  oz.  vj.     Mix.     One-sixth  part  every  four  hours. 

The  quantity  of  antimonial  wine  should  be  doubled  when  it  is  desirable  to  induce 
nausea. 

241.  Ipecacuan  and  Indian  Sarsaparilla. 

U.   Yini  Ipecacuanhje,   fl.   drs.   ij  ;   Syrupi   Hemidesmi,   fl    drs.   iij  ;   Mucilaginis 
Acaciffi,  fl.  oz.  j  ;  Aquje,  ad  fl.  oz.  ij.     Mix.     One  teaspoonful  every  two  hours. 
Tor  children  threatened  with  an  attack  of  croup  or  bronchitis. 

R.  Yini  Ipecacuanhse,  fl.  drs.  i j ;  Syrupi  Hemidesmi,  fl.  oz.  j  ;  Infusi  Lini,  ad  fl. 
oz.  viij.     Mix.     One-sixth  part  every  four  hours. 
An  emollient  and  expectorant  in  catarrh. 

242.  Indian  Tobacco  and  Hemlock. 

R.  Tincturse  Lobelife  yEtherese,  fl.  drs.  iij  ;  Syrupi  Papaveris,  fl.  drs.  vj  ;  Tincturse 
Conii  Fructus,  fl.  drs.  ij — iv  ;  Misturse  Amygdahe,  ad  fl,  oz.  vj.  Mis.  One-sixth 
part  every  four  hours. 

In  spasmodic  cough,  and  some  forms  of  asthma. 

243.  Squills  and  Hemlock. 

R.  Pilulffi  Scillfe  Composite,  Extracti  Conii,  aa  gr.  30.     Make  a  mass,  divide  into 
twelve  pills,  and  order  two  to  be  taken  every  night  at  bedtime. 
In  chronic  catarrh  when  opium  is  objectionable. 

244.  Nitrous  Uthcr,  IpecacuanJia,  and  Hemlock. 

R.  Yini  Ipecacuanha,  fl.  drs.  iss ;   Spiritus  ^Etheris  !Nitrosi,  fl.  drs.  vj  ;  Succi  Conii, 
fl.  drs.  iij  ;  Infusi  Senegas,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 
In  chronic  bronchitis,  when  an  expectorant  and  sedative  is  required. 

245.  Didcamara  and  Stramonium. 

R.  Tinctura3  Scilla3,  fl.  drs.  ij  ;  Tincture  Stramonii,  fl.  drs.  iss;  Infusi  Dulcamarse, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  chronic  catarrh  and  rheumatism,  esj^ecially  where  the  secretions  of  the  skin  and 
kidneys  are  deficient. 

246.  Benzoic  Acid  and  Squills. 

R.  Acidi  Bonzoici,  gr.  40;  Syrupi  Scillae,  Syrupi  Rhceados,  aa  fl.  oz.  iss.     Make  a 
linctus,  of  which  one  small  teaspoonful  is  to  be  ordered  to  be  taken  every  four  hours. 
In  chronic  bronchial  atiections  with  suppressed  action  of  the  liver.     See  F.  49. 

247.   Opium  and  Squills. 

R.  Syrupi  Scillfc,  Syrupi  Papaveris,  Syrupi  Limonis,  Mucilaginis  Tragacanthse, 
aa  fl.  drs.  iv.  Make  a  linctus,  of  which  a  teaspoonful  is  to  be  directed  to  be  taken 
frequently. 

R.  Syrupi  Scilla},  fl.  drs.  xij  ;  Tincturaj  Camphors  cum  Opio,  fl.  drs.  iv.  Make  a 
linctus,  and  order  one  teaspoonful  to  be  taken  when  the  cough  is  troublesome. 


XII.  GARGLES  AND  INHALATIONS. 

248.  Hydrocldo7'ic  Acid  Gargle,  (J-'c. 

R.  Acidi  Hydrochlorici   Diluti,   fl.  drs.  iij  ;  Mellis  Dcjuirati,  oz.  1  ;  Infusi  Eosae 
Acidi,  ad  fl.  oz.  viij.     Mix. 
In  tonsillitis  after  the  acute  stage,  and  in  relaxed  sore  throat. 


GARGLES  AND  INHALATIONS.  327 


249.  Zinc  and  Rhatany  Gargle. 

R.   Zinoi  Sulphatis,  "jr.  20;  Syrupi  Mori,  fl.  drs.  iv;  Glycerini,  fl.  oz.  j  ;  Infusi 
Kraineriie,  ad  fl.  oz.  viij.     Mix. 
For  relaxation  of  the  uvula  and  fauces. 

250.  Borax  Gargles. 

R.  Borncis,  G^r.  160;  Tinctura;  Myrrhaj,  fl.  oz.  j  ;  Aqua?,  ad  fl.  oz.  viij.     Mix. 
Useful  in  aphtha)  and  ulcerations  about  the  fauces. 

R.  Boracis,  gr.  120;  Glycerini,  fl.  oz.  j.  Mix.  To  bo  painted  over  the  gums, 
tongue,  &c.,  with  a  camel's-hair  pencil. 

In  aphtha?.  It  is  preferable  to  the  ofiicinal  Borax  Honey,  as  the  sugar  of  the 
latter  favors  the  formation  of  fungi. 

R.  Boracis,  gr.  60  ;  Glycerini,  fl.  drs.  xij  ;  Aquae  Kosse,  ad  fl.  oz.  iv.     Mix. 
To  be  painted  over  the  tongue  in  some  forms  of  ulceration,  fissure,  &c. 

R.  Boracis,  gr.  180;  Syrupi  Scilla;,  fl.  oz.  j ;  AquiB,  ad  fl.  oz.  viij.     Mix. 
As  a  gargle  in  chronic  inflammation  of  the  fauces. 

251.   Tannin  Gargle. 

R.  Acidi  Tannici,  gr.  20;  Spiritus  Vini  Gallici,  fl.  oz.  j  ;  Aquae  Camphoraa,  ad  fl. 
oz.  viij.     Mix. 

252.  Alum  and  Myrrh  Gargle. 

R.  Aluminis  Exsiccati,  gr.  80;  Tincture  Myrrhae,  fl.  oz.  j  ;  Aquae,  ad  fl.  oz.  viij. 
Mix. 
In  mercurial  salivation,  ulceration  about  the  mouth  and  fauces,  &c. 

253.   Opium  and  Belladonna  Gargle. 

R.  Tincturte  Opii,  fl.  drs.  ij  ;  Tincturae  Belladonnse,  fl.  drm.  j  ;  Aquie  Camphors, 
ad  fl.  oz.  viij.     Mix. 

To  be  used  frequently  in  acute  tonsillitis. 

254.   Chlorinated  Soda  Gargle. 

R.  Liquoris  Soda3  Chloratae,  fl.  drs.  vj  ;  Aqufe,  ad  fl.  oz.  viij.     Mix. 
In  ulcerated  sore  throats,  profuse  salivation,  &c.     It  may  also  be  used  as  a  lotion 
to  foul  gangrenous  ulcers,  as  well  as  to  the  seat  of  irritation  in  prurigo. 

255.   Creasote  Gargles. 

R.  Creasoti,  min.  xx ;  Mucilaginis  Tragacanthae,  fl.  oz.  iij  ;  .Aquae,  ad  fl.  oz.  viij. 
Mix. 

R.  Creasoti,  min.  XX ;  Tincture  Lavandula  Compositae,  Tincturie  Myrrhse,  aa  fl. 
drs.  iv ;  Syrupi  Limonis,  fl.  drs.  xij  ;  Aqua\  ad  fl.  oz.  viij.     Mix. 
In  chronic  inflammation  of  the  throat,  dysphonia  clericorum,  &c. 

256.  Corrosive  Sublimate  Gargles. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  2;  Acidi  Nitrici  Diluti,  min.  xxx ;  Tinc- 
turae  Myrrhae,  fl.  oz.  j  ;  Aquae,  ad  fl.  oz.  viij.     Mix. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  3 ;  Glycerini,  fl.  oz.  j  ;  Extracti  Conii, 
gr.  60  ;  Aquie,  ad  fl.  oz.  viij.     Mix. 

Useful  in  syphilitic  aftections  of  the  tongue  and  throat.  The  patient  must  use  one 
tablespoonful  at  a  time,  and  should  be  cautioned  against  swallowing  it. 

257.  Capsicum  and  Alum  Gargle. 

R.  Aluminis  Exsiccati,  gr.  100;  Tincturae  Capsici,  fl.  drs.  ij  ;  Syrupi  Mori,  fl. 
oz.  j  ;  Aqute  Rosre,  ad  fl.  oz.  viij.     Mix. 

In  hoarseness,  sore  throat,  &c.,  with  relaxation  of  the  uvula  or  tonsils. 


328 


APPENDIX    OF    FORMULA. 


258.  Sulphite  of  Soda. 

R.  Sodre  Sulphitis,  gr.  60;  AqujB  Destillatne,  fl.  oz.  j.  Mix.  To  be  frequently 
applied  by  means  of  a  camel's-hair  pencil  to  the  mucous  membrane  of  the  mouth  and 
fauces. 

In  cases  of  aphthae. 

259.  Iodine  Inhalation. 

R.  Tincturse  lodi,  min.  xxx  ;  Aquse  Calida?,  fl.  oz.  iv.  Mix.  The  vapor  is  to 
be  cautiously  inhaled. 

In  some  cases  of  laryngeal  phthisis. 

In  severe  coryza  great  relief  is  given  by  holding  a  small  bottle  of  Tincture  of  Iodine 
under  the  nose.     The  warmth  of  the  hand  suffices  to  vaporize  the  iodine. 

260.   Turpentine  and  Creasote  Inhalations. 

R.  Olei  Terebinthinfe,  fl.  oz.  j  ;  AquteCalidaa,  ad  fl.  oz.  vj.     Mix. 

In  chronic  bronchitis  with  excessive  secretion.    To  be  used  with  a  common  inhaler. 

R.  Creasoti,  min.  xxx ;  Aquae  Bullientis,  fl.  oz.  viij.     Mix. 
In  ozjena  and  other  affections  of  the  nostrils,  pharynx,  «&c. 

261.  Hydrocyanic  Acid  Inhalations. 

R.  Acidi  Hydrocyanici  Diluti,  min.  xx  ;  Tincturie  Hyoscyami,  Tinctura;  Lupuli,  aa 
fl.  oz.  j  ;  Aquie  Calidre,  ad  fl.  oz.  viij.     Mix. 

In  phthisis,  ulceration  of  the  larynx,  &c.     Can  be  used  with  any  common  inhaler. 

R.  Acidi  Hydrocyanici  Diluti,   min.   xv  ;  Spiritfis  Chloroformi,  fl.  drs.  iij — vj  ; 
Aqua3  Bullientis,  fl.  oz.  viij.     Mix. 
In  laryngitis,  oedema  of  the  glottis,  &c. 


262.  Atomized  Fluids  for  Inhalation. 


The  following  drugs  may  be  used  in  the  form  of  spray. 
be  added  to  one  ounce  of  water  : 


The  dose  mentioned  is  to 


Alumen  Exsiccatum,  .  . 
Acidum  Tannicum,  .  . 
Argenti  Nitras,  .  .  .  . 
Aqua  Laurocerasi,  .     .     . 

Borax, 

Extractum  Belladonnaj,  . 
Extractum  Conii,    . 
Extractum    Cannabis  In- 

dicse, 

Extractum  Opii,  .  .  . 
Hydrargyrum        Corrosi- 

vum  Sublimatum, 


grs. 

5  to 

30. 

grs. 

3  to 

12. 

grs. 

1  to 

5. 

nm. 

V  to 

XX. 

grs. 

5  to 

20. 

gr. 
grs. 

}  to 
5  to 

1. 
10. 

gr. 
gr. 

i  to 
i  to 

1. 

2. 

gr. 


to 


grs. 
errs. 


Liquor    Calcis    Sacchara- 

tus, 

Oleum  Terebinthinje, 
Potassie  Chloras,  . 
Potassii  Bromidum, 
Potassii  lodidum,  . 
kSodii  Chloridum,  . 
Tinctura   Fcrri    Perchlo- 

ridi, min, 

Tinctura  lodi,     ....  min, 
Zinci  Sulphas,     ....    grs. 


min.  XV  to  xc. 
min.  j  to    V. 


grs. 


to  10. 
to  10. 
to  10. 
to  40. 


V  to  xxx. 
j  to  XV. 
3  to     15. 


The  best  instruments  for  dispersing  the  finest  sjiray  arc, — Dr.  Sicgle's,  in  which 
steam  is  applied  as  the  dispersing  medium  :  a  modification  of  this  a])paratus,  made  by 
Krohne,  241  Whitechapel  lioad :  Dr.  Andrew  Clarke's  double  handball  spray-pro- 
ducer :   Mr.  Maunder's  single  handball. 

Atomized  medicated  fluids  may  be  advantageously  used  in  affections  of  the  lining 
membrane  of  the  nose,  mouth,  and  fauces.  In  croup,  and  diphtheria.  Syphilitic 
affections  of  palate  and  throat.  Laryngitis.  CEdema  of  the  glottis.  Tubercular  or 
sy|)hilitic  ulcerations  of  larynx.  Hoarseness  and  loss  of  voice.  Hoo|)ing-cough. 
Bronchitis.  Plitliisis.  During  their  apjjlication  the  patient  should  make  deep  and 
long  inspirations  and  expirations.  Excej)!  in  acute  cases,  one  application  daily  will 
suffice. 


LOTIONS,    LINIMENTS,    ETC.  329 


XIII.  LOTIONS,  LINIMENTS,  COLLYRIA,  AND   OINT- 
MENTS. 

263.  Hydrocyanic  Acid  Lotions. 

R.  Acidi  Hvclrocyaiiici  Diluti,  fl.  drs.  iij  ;  Plumbi  Acetatis,  gr.  60;  Spiritus  Rec- 
tific'iiti,  fl.  07..  j  ;   A(jna>  Sambuci,  ad  fl.  oz.  viij.     Mix. 
In  impetigo,  prurigo,  &c. 

R.  Liquoris  PotasssG,  fl.  drs.  ij ;  Acidi  Hydrocyanici  Diluti,  fl.  drs.  iss  ;  Glycerini, 
fl.  oz.  j  ;  Aquaj  Eosa^,  ad  fl.  oz.  viij. 
In  some  cases  of  pityriasis. 

R.  Liquoris  Ammonia  Acetatis,  fl.  oz.  j  ;  Acidi  Hydrocyanici  Diluti,  A- drs.  iss; 
Infusi  Tabaci  (made  with  sixty  grains  of  Bird's-eye  tobacco),  ad  fl.  oz.  viij.  Mix. 
To  be  sponged  twice  or  thrice  daily  over  the  seat  of  irritation. 

In  pruritus  about  the  anus,  vulva,  &c. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  3;  Acidi  Hydrocyanici  Diluti,  fl.  drs.  iss; 
Mistunx?  Amygduliip,  ad  fl.  oz.  viij.     Mix. 

To  check  the  irritation  in  prurigo  and  other  skin  diseases. 

264.  Astringent  Lotions. 

R.  Glycerini,  fl.  oz.  j  ;  Liquoris  Plumbi  Subacetatis,  fl.  drs.  ij  ;  Spiritus  Eectificati, 
fl.  drs.  iv  ;  Aqu£e  Ros;w,  ad  fl.  oz.  viij.     Mix. 
In  eczema,  ecthyma,  pityriasis,  &c. 

R.  ZinciSulphatis,  gr.  16;  Spiritus  Rosmarini,  Tinctura?  Lavandulae  Compositse, 
aa  fl.  drs.  ij  ;  Aquae,  ad  fl.  oz.  viij.     Mix. 

The  common  "  Red  Lotion"  of  Hospitals.  Very  useful  for  strumous  and  other 
ulcers. 

R.  Potassce  Chloratis,  gr.  80;  Aqua?,  fl.  oz.  viij.     Mix. 
For  many  ill-conditioned  ulcers. 

R.  Acidi  Citrici,  gr.  120;  Aquae,  fl.  oz.  viij.     Mix. 

Por  cancerous  sores.  Also  as  a  gargle  in  cancer  of  the  tongue  or  tonsil.  It  relieves 
pain,  and  encourages  cicatrization. 

265.  Anodyne  Lotions. 

R.  Tincturae  Aconiti,  fl.  oz.  iss;  Aquie,  ad  fl.  oz.  iv.     Mix. 
In  acute  superficial  pain,  hyperaesthesia  of  skin,  pruritus,  &c. 

R.  Tabaci  Communis,  gr.  120;  Aquro  Bullientis,  Oj.  Infuse  for  an  hour,  and 
strain. 

To  be  freely  used  in  pruritus  of  the  vulva  or  anus. 

R.  Tincture  Belladonna,  fl.  oz.  j  ;  Spiritiis  Chloroformi,  fl.  oz.  ij  ;  Aquaj  Destillatie, 
ad  fl.  oz.  viij.     Mix. 

R.   Extracti  Belladonna,  gr.  120;   Glycerini,  fl.  oz.  j.     Mix. 
To  be  painted  over  the  seat  of  pain  in  neuralgic  diseases. 

266.  Alkaline  and  Anodyne  Lotions. 

R.  Liquoris  Morphiae  Hydrochloratis,  fl.  oz.  iss;   Liquoris  Potassae,    fl.  drs.   ij  ; 
Glycerini,  fl.  oz.  j  ;   Aqua^  Laurocerasi,  fl.  oz.  j  ;  Aquae  Sambuci,  ad  fl.  oz.  viij.     Mix. 
For  the  relief  of  pruriginous  aflections. 

R.  Potassae  Sulphuratje,  gr.  60;  Liquoris  Potasste,  min.  xxx ;  Tincturae  Aconiti, 
fl.  drs.  iv;  Aquaj  Destillat^,  ad  fl.  oz.  viij.     Mix. 

267.  Acid  and  Anodyne  Lotion. 

R.  Acidi  Acetici,  fl.  drs.  iss;  Morphia  Acetatis,  gr.  10;  Vini  Colchici,  fl.  oz.  iij. 
Mix. 

To  be  applied  over  the  inflamed  joint  in  gout,  on  a  piece  of  lint  covered  with  oiled 
silk. 


330  APPENDIX    OF    FORMULA. 


268.  Borax  or  Soda,  and  Glycerine  Lotions. 

R.  Boracis,  gr.  60 — 120;  Gh^cerini,  fl.  oz.  j  ;  Aquas  Sambuci,  ad  fl.  oz.  viij.     Mix. 
An  excellent  local  palliative  in  many  of  the  squamous  diseases  of  the  skin. 

R.  Boracis,  gr.  200;  Morphife  Hydrochloratis,  gr.  10;  Glycerini,  tl.  oz.  j  ;  Aquoe 
Eosse,  ad  fl.  oz.  viij.     Mix. 

In  obstinate  pruritus  of  the  vulva.  The  parts  to  be  sponged  twice  or  thrice  in  the 
twenty-four  hours  with  this  lotion,  previously  washing  them  with  glycerine  (or 
honey)  soap  and  warm  water. 

R.  Sodse  Carbonatis,  gr.  120;  Aqute  Sambuci,  fl.  oz.  vij  ;  Glycerini,  fl.  oz.  j.    Mix. 
To  allay  the  itching  attendant  on  many  skin  diseases,  healing  ulcers,  &c. 

269.  Iodine  Lotions. 

R.  Tincturae  lodi,  fl.  oz.  j  ;  Glycerini,  fl.  drs.  xij  ;  Aquaj  Destillatse,  ad  fl.  oz.  viij. 
Mix. 

For  indolent  and  scrofulous  ulcers,  &c. 

R.  Linimenti  lodi,  fl.  drs.  iv  ;  Tincturse  Aconiti,  fl.  oz.  j  ;  Aquae  Destillata?,  ad  fl. 
oz.  viij.     Mix. 

In  some  cases  of  chronic  peritonitis  ;  chronic  pleurisy  with  efi"usion;  chronic  eftu- 
sions  into  joints,  «S:c.     See  F.  81. 

270.   Creasote,  or  Carbolic  Acid,  and  Glycerine. 

R.  Creasoti,  min.  xxxv;  Glycerini,  fl.  drs.  xij;  Aquae,  ad  fl.  oz.  viij.  Mix,  for  a 
lotion. 

In  pityriasis,  &c. 

R.  Acidi  Carbolici,  fl.  drm.  j  ;  Glycerini,  fl.  oz.  j  ;  Aquae,  ad  fl.  oz.  viij.  Mix,  for 
a  lotion. 

In  pruriginous  afi"ections. 

271.    Corrosive  Sublimate  Lotion. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  4 — 6;  Aqufe  Destillatae,  fl.  oz.  iij.     Mix. 
Useful  in  tinea  favosa,  and  other  parasitic  skin  diseases. 

272.  Sulphurous  Acid  Lotion. 

R.  Acidi  Sulpburosi,  fl.  oz.  j  ;  Aquae  Destillatae,  fl.  oz.  vij.     Mix. 
In  skin  diseases  dependent  on  a  parasitic  plant. 

273.  Cold  Lotions. 

R.  Liquoris  Ammonia  Acetatis,  fl.  oz.  j  ;  Spiritus  Kectificati,  fl.  oz.  ij  ;  Aqu«  EosiB, 
ad  fl.  oz.  viij.     Mix. 

As  an  evaporating  lotion  in  inflammation  of  the  membranes  of  the  brain.  To  be 
applied  after  the  scalp  has  been  shaved. 

R.  Ammonias  Hydrochloratis,  oz.  ^;  Spiritus  Eectiflcati,  fl.  oz.  j  ;  Acidi  Acetici 
Diluti,  fl.  drs.  xij  ;  Aqua^,  ad  fl.  oz.  viij.     Mix. 

274.  Absorbent  Lotions. 

R.  Zinci  Oxidi,  gr.  100;  Aquae  Eosa;,  ad  fl.  oz.  viij.     Mix. 
Useful  in  impetigo,  eczema,  &c. 

R.  Zinci  0.xidi,  gr.  IGO;  Mucilaginis  Tragacanthao,  Aquaj  Destillata?,  ati  fl.  oz.  iv. 
Mix. 

275.  Solutions  of  Arnica. 

R.  Tincturae  Arnicae,  fl.  drs.  j — vj  ;  Aqua?  Destillataj,  ad  fl.  oz.  viij.     Mix. 
As  a  lotion  in  sprains,  contusions,  and  burns. 

R.  Tincturae  Arnicaj,  fl.  drs.  ij  ;  Tincturie  Belladonnie,  fl.  oz.  j  ;  Linimenti  Saponis, 
ad  fl.  oz.  viij.     Mix,  for  an  embrocation. 


LOTIONS,    LINIMENTS,    ETC.  331 


27G.  3I(ircurial  Liniments. 

R.  Linimenti  Hydrargyri,  fl.  oz.  ij  ;  Linimenti  Belladonnas,  Linimenti  Opii,  uii  fl. 
oz.  j.     Mix. 

In  syphilitic  tubercles,  nodes,  «&c. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  8;  Aquae  Destillatae,  fl.  oz.  viij.     Mix. 
To  be  used  every  night  in  cases  of  chloasma. 

R.  Unguenti  Hydrargyri,  oz.  1 ;  Glyccrini,  fl.  oz.  j  ;  lodi,  gr.  120;  Olei  Oliva?,  fl. 
oz.  ij.     Mix. 

To  be  gently  rubbed  over  syphilitic  nodes. 

277.  Rubefacient  Liniment. 

R.  Pulveris  Capsici,  gr.  30;  Olei  Macis,  min.  xxx ;  Linimenti  Terebinthinse,  fl. 
oz.  iij ;   Linimenti  Camphoric  Compositi,  ad  fl.  oz.  viij.     Mix. 
As  a  liniment  to  the  chest  in  some  cases  of  bronchitis. 

278.  Stimulating  Liniment. 

R.  Linimenti  Saponis,  Linimenti  Opii,  Linimenti  Camphorae  Compositi,  aa  fl.  oz. 
j  ;  Tinctur?e  Arnicas,  fl.  drs.  ij.     Mix. 

To  be  applied  round  the  throat,  on  a  strip  of  flannel,  in  subacute  tonsillitis,  common 
sore  throat,  «S:c. 

279.   Gamyhor  Liniment  and  Opium,  ^c. 

R.  Linimenti  Camphorae  Compositi,  fl.  oz.  ij  ;  Tincturse  Opii,  Tincturse  Bella- 
donnas, au  drs.  iv.     Mix. 

To  be  rubbed  over  the  scrobiculus  cordis  to  check  obstinate  nausea  and  vomiting, 
pain,  &c. 

280.  Iodide  of  Potassium  Liniment. 

R.  Potassii  lodidi,  vel  Ammonii  lodidi,  gr.  40;  Aquse,  fl.  drs.  iv.  Mix,  and  add — 
Glycerini,  fl.  oz.  j. 

Useful  in  some  glandular  enlargements,  as  "well  as  for  dispersing  the  chalk-stones 
of  gout. 

281.  Belladonna  and  Aconite  Liniment. 

R.  Linimenti  Belladonnas,  Linimenti  Aconiti,  aa  fl.  drs.  iv ;  Linimenti  Camphorse 
Compositi,  fl.  oz.  iij.  Mix.  The  seat  of  pain  to  be  rubbed  with  this  liniment  for  ten 
minutes  at  bedtime. 

In  pleurodynia,  chronic  rheumatism,  and  painful  nervous  affections. 

For  the  same  class  of  cases  a  good  liniment  may  be  made  with  one  part  of  bella- 
donna liniment,  one  of  opium  liniment,  and  four  of  turpentine  liniment. 

R.  Linimenti  Belladonna,  fl.  drs.  iij;  Glycerini,  fl.  drs.  v;  Linimenti  Saponis,  fl. 
oz.  ij.  Mix.  The  spine  to  be  rubbed  with  this  liniment  night  and  morning  for  five 
minutes. 

In  hooping-cough. 

May  be  used  for  a  child  five  years  old. 

282.   Chloroform,  Belladonna,  and  Aconite  Liniment. 

R.  Linimenti  Chloroformi,  Linimenti  Aconiti,  Linimenti  Belbulonna?,  Linimenti 
Opii,  aa  fl.  oz.  ss ;  Linimenti  Saponis,  fl.  oz.  j.  Mix.  To  be  rubbed  into  the  painful 
part  night  and  morning. 

In  neuralgic  and  rheumatic  pains  of  great  severity. 

283.   God-Liver  Oil  Embrocations. 

R.  Olei  Morrhuae,  fl.  oz.  iiiss  ;  Spiritus  Ammonias  Aromatici,  fl.  oz.  j  ;  Tincturae 
Opii,  fl.  drs.  iv ;  Olei  Lavandula?,  min.  xxx.  Mix.  One-half  to  be  well  rubbed  over 
the  chest  and  abdomen,  nio-ht  and  morning;. 


832  APPENDIX    OF    FORMULA. 

In  phthisis  and  other  cases  where  the  use  of  cod-liver  oil  is  indicated,  but  where  the 
stomach  will  not  bear  it. 

R.  Olei  Morrhufe,  fl.  oz.  j  ;  Olei  Cajuputi,  fl.  drm.  j.  Mix.  To  be  rubbed  over 
the  chest  at  bedtime. 

The  cajuput  oil  well  disguises  the  smell  of  this  embrocation. 

284.   Caoutchouc  Solution. 

Take  some  thin  pieces  of  Indian  rubber,  or  of  pure  gutta-percha,  and  dissolve  them 
in  chloroform.     A  good  protective  solution. 

To  be  painted  over  superficial  excoriations,  threatened  bed-sores,  &c. 

285.   CoUodium  Paints. 

R.  Collodii,  fl.  oz.  j ;  Olei  Palmae,  min.  xx ;  Anchusse  Eadicis,  sufficient  to  give 
color. — A  good  artificial  cuticle,  which  when  spread  on  the  skin  will  not  crack,  may 
also  be  formed  by  mixing  two  parts  of  glycerine  with  one  hundred  of  collodium — A 
similar  preparation  can  be  made  with  one  part  of  collodium  to  two  of  castor  oil. 

Either  preparation  may  be  used  as  a  varnish  in  various  cutaneous  affections,  excoria- 
tions, or  superficial  burns. 

286.   Crlycerine  and  Lime-  Water. 

R.  Glyeerini,  fl.  oz.  j  ;  Pulveris  Tragacanthse  Compositi,  gr.  120;  Mellis  Depurati, 
gr.  120;  Liquoris  Calcis  Saccharati,  fl.  oz.  iss ;  Misturse  Amygdalse;  ad  fl.  oz.  viij. 
Mix. 

A  good  bland  embrocation  in  cases  of  herpes,  superficial  burns,  chapped  hands,  ex- 
coriations, &c. 

The  officinal  Linimentum  Calcis,  consisting  of  equal  parts  of  olive  oil  and  lime- 
water,  is  also  useful  in  some  of  the  above-mentioned  cases. 

287.  Ammonia  and  Cantharides,  ^c. 

R.  Spiritus  Ammonife  Aromatici,  Spiritus  Rosmarini,  Glj'cerini,  aa  fl.  oz.  j  ;  Tinc- 
turse  Cantharidis,  fl.  drs.  iij — vj  ;  Aquas  Eosa?,  ad  fl.  oz.  viij.     Mix. 

To  be  gentlj'  brushed  into  the  scalp  night  and  morning,  when  the  hair  is  falling  off" 
after  fever  or  any  severe  illness. 

A  more  elegant  embrocation  may  be  made  by  adding  two  fluid  drachms  of  Tincture 
of  Cantharides  to  two  ounces  of  Eau  de  Cologne. 

R.  Balsami  Tolutani,  gr.  120;  Olei  Rosmarini,  min.  xx;  Tincturse  Cantharidis,  fl. 
drs.  iv ;  Olei  Ricini,  fl.  oz.  j  ;  Adipis  Prueparati,  oz.  1.     Mix. 

A  valuable  pomade  in  cases  of  baldness  following  ringworm,  pityriasis,  or  tinea 
decalvans.     It  should  be  brushed  into  the  scalp  night  and  morning. 

288.  Sulidliate  of  Atropia. 

R.  Atropise  Sulphatis,  gr.  1 ;  Aquae  Destillata?,  fl.  drs.  iv.     Mix. 

Dilatation  of  the  pupil  is  effected  most  speedily  and  is  longest  maintained  by  a  solu- 
tion of  this  kind.  A  full  drop  must  be  placed  in  the  eye  by  means  of  a  camel's  hair 
pencil :  the  effect  will  be  produced  in  from  fifteen  to  twenty  minutes,  and  will  some- 
times continue  for  seven  or  eight  days. 

The  officinal  Liquor  Atropine  contains  half  a  grain  of  the  alkaloid  in  each  drachm. 
But  the  spirit  which  is  used  to  keep  it  in  solution  causes  considerable  pain  to  the  eyes 
when  it  is  applied. 

Discs  of  gelatine  impregnated  ^ith  atropine  are  prepared  according  to  the  instruc- 
tions of  Mr.  Ernest  Hart  and  Mr.  Streatfeild.  These  discs  dissolve  and  act  very 
efficiently  when  placed  in  contact  with  the  moist  conjunctiva.  A  piece,  one-fifth  of  an 
inch  square,  contains  as  much  of  the  Sulphate  of  Atropine  as  a  drop  of  the  solution  of 
two  grains  to  the  ounce  of  water. 

289.  Alum  Coagulum. 

Take  the  whites  of  two  eggs,  and  shake  them  with  fragments  of  alum  to  form  a 
coagulum. 

Useful  when  painted  under  the  eyelid  to  produce  contraction  in  trichiasis,  en- 
tropion, &c. 


LOTIONS,    LINIMENTS,    ETC.  333 


200.  Sedative  Collyria. 

R.  Extract!  Belladonna,  gr.  3 — 10;  vel  Extract!  Opii,  gr.  2 — 5;  vel  Morphia;  Hy- 
drocliloratis,  gr.  1 — 2,  wei  Acidi  Hydrocyauici  Dikiti,  min.  x;  vei  Tincturje  Aconiti, 
mill.  V — XXX  ;  Aqute  Destillatse,  fl.  oz.  j.     Mix. 

291.  Astringent  Collyria. 

R.  Zinci  Sulphatis,  gr.  2 — 4 ;  vel  Aluminis  Exsiccati,  gr.  1 — 4 ;  vel  Tincturse  Arnicse, 
min.  V — XXX  ;  ^e^  Cupri  Sulphatis,  gr.  1 — 4;  vel  Argenti  Nitratis,  gr.  1 — 'l;^vel  Liq- 
uoris  Plumbi  Subacetatis,  min.  x ;  vel  Cadmii  Sulphatis,  gr.  1 — 3 ;  Aquae  Destillatse, 
fl.  oz.  j.     Mix. 

R.  Zinci  Oxidi,  gr.  60;  Aquae  Roaj,  fl.  oz.  viij.  Mix.  For  an  eye- water,  to  be  used 
night  and  morning. 

292.  Iodide  of  Potassium  Collyrium. 

R.  Potassii  lodidi,  gr.  6 — 8;  Aqua?  Destillatse,  fl.  oz.  j.     Mix. 
To  remove  stains  of  nitrate  of  silver  from  the  conjunctiva. 

293.  Iodide  of  Lead.  Ointments. 

R.  Plumbi  lodidi,  gr.  60;  Unguenti  Atropiae,  gr.  60 — 120  (each  ounce  contains 
eight  grains  of  the  alkaloid) ;  Unguenti  Simplicis,  ad  oz.  1.     Mix. 
In  some  malignant  ulcerations. 

R.  Plumbi  lodidi,  gr.  90;  Unguenti  Cetacei,  oz.  1;  Linimenti  Belladonnae,  vel 
Linimenti  Aconiti,  fl.  drm.  j.     Mix. 

For  malignant  and  painful  strumous  ulcers. 

294.  Sulphate  of  Zinc  Ointment. 

R.  Zinci  Sulphatis  Exsiccatae,  gr.  120;  Unguenti  Simplicis,  oz.  1.     Mix. 
Very  useful  in  some  forms  of  lupus,  rodent  ulcer,  &c.    The  ofliciual  Altjmex  Exsic- 
CATUM  may  be  employed  in  the  same  cases. 

295.  Tar  and  Citrine  Ointment. 

R.  Unguentum  Picis  Liquidae  (Phar.  Lond.   1851),  oz.   1^;  Unguenti  Cetacei,  oz. 
1 ;   Unguenti  Hydrargyri  Nitratis,  oz.  h.     Mix. 
In  lepra,  psoriasis,  chronic  eczema,  &c. 

296.  Aconitine  Ointments. 

R.  Unguenti  Aconitiae,  oz.  \  {=  to  grs.  2  of  the  alkaloid) ;  Unguenti  Calomelanos, 
oz.  1 — 2.     Mix. 

In  some  forms  of  neuralgia. 

R.  Aconitiae,  gr.  2;  Spirittis  Eectificati,  guttae  vj.  Mix  thoroughly,  and  add-^ 
Adipis  Prajparati,  gr.  60. 

Recommended  by  Dr.  Turubull  for  severe  neuralgia.  A  small  portion  is  to  be 
painted  over  the  nerve,  but  it  must  not  be  used  where  there  is  the  slightest  abrasion. 

297.  Belladonna  and  Opium. 

R.  Extract!  Belladonnae,  Extract!  Opii,  afi  gr.  90;  Glycerini,  fl.  drs.  iv ;  Exti'acti 
Papaveris,  oz.  1^.     Mix. 

To  be  painted  over  the  seat  of  inflammation  in  pleurisy,  peritonitis,  gastric  disease, 
&c.  A  fomentation  flannel,  or  hot  linseed  poultice,  or  wet  compress  is  to  be  applied ; 
being  separated  from  the  extracts  by  a  sheet  of  tissue  paper. 


334  APPENDIX   OF   FORMULA. 


298.  3Iercurial  and  Opiate  Ointments. 

R.  Unguenti  Hydrargyri,  gr.  10;  Pulveris  Opii,  gr.  2.     Mix. 

Recommended  by  Dr.  Watson  in  cases  of  severe  nocturnal  pain  around  the  orbit. 
It  is  to  be  rubbed  into  the  temple  just  before  the  pain  may  be  expected. 

R.  Hydrargyri  Corrosivi  Sublimati,  gr.  5 ;  Pulveris  Opii,  gr.   10;   Unguenti  Sim- 
plicis,  oz.  1.     Mix. 
In  chloasma,  &c. 

299.  Calomel  and  Belladonna  Ointment. 

R.  Linimenti  Belladonna;,  fl.  drs.  ij  ;  Unguenti  Calomelanos,  oz.  1.     Mix. 
In  syphilitic  tubercular  diseases. 

300.  Ammoniated  Mercury  and  Sulphur. 

R.  Unguenti  Hydrargyri  Ammoniati,  gr.  120;  Unguenti  Sulphuris,  gr.  360- 
Mix. 

A  good  antiparasitic  ointment. 

301.   Creasote  and  Red  Oxide  of  3Iercury. 

R.  Creasoti,  min.  x;  Unguenti  Hydrargyri  Oxidi  Rubri,  gr.  120;  Unguenti  Sim- 
plicis,  gr.  860.     Mix. 

In  parasitic  diseases  of  the  skin,  the  ulcerations  of  rupia,  »&c. 

302.  Red  Iodide  of  Mercury  Ointment. 

R.  Hydrargyri  lodidi  Rubri,  gr.  8 ;  Unguenti  Simplicis,  oz.  1.     Mix. 

In  chronic  glandular  tumors,  a  small  portion  rubbed  in  every  night  proves  very 
useful.  The  officinal  ointment  is  double  the  strength  of  the  foregoing,  and  hence  it 
causes  pain  and  blistering. 

303.  Croton  Oil  and  Lard. 

R.  Olei  Crotonis,  min.  xv ;  Adipis  Prseparati,  oz.  J.  Mix.  One-fourth  part  to  be 
rubbed  into  the  skin  every  eight  hours,  until  an  abundant  pustular  eruption  is  pro- 
duced. 

Useful  as  a  counter-irritant. 

304.    Ver atria  Ointment. 

R.  Unguenti  Veratriae,  Unguenti  Potassii  lodidi,  aa  oz.  1.     Mix. 
In  chronic  rheumatism,  chronic  gout,  «fcc. 

305.  Diluted  Citrine  Ointment. 

R.  Unguenti  Hydrargyri  Nitratis,  gr.  40 — 120;   Unguenti  Cetacei,  gr.  240.     Mix. 
As  a  stimulant  and  alterative  in  chronic  skin  diseases.    May  be  applied  to  the  edges 
of  the  eyelids  in  ophthalmia  to  prevent  their  adhering  at  night. 

306.  Compound  Spermaceti  Ointments. 

R.  Acidi  Hydrocyanici  Diluti,  11.  drm.  j  ;  Unguenti  Atropia;,  gr.  120 ;  Unguenti 
Cetacei,  oz.  1.     Mix. 

In  cutaneous  diseases  attended  with  pain  or  itching. 

R.  Balsami  Peruviani,  gr.  60;  Unguenti  Cetacei,  oz.  1.     Mix. 
In  slight  excoriations. 

R.  Balsami  Peruviani,  gr.  60;  Unguenti  Cetacei,  oz.  2;  Alkannse  Tinctoriae 
Eadicis,  gr.  00;  Olei  Rosie  (Otto  of  Roses),  min.  x.     Mix. 

Useful  as  a  lip-salve,  and  as  an  application  to  chapjied  hands  and  sore  nipples. 


NAllCOTICS    AND    SEDATIVES.  335 


807.  Belladonna  and  Iodide  of  Potassium. 

R.  Linimonti  Belladonnyo,  fl.  drs.  ij  ;  Unguenti  Potassii  lodidi,  oz.  1.  Mako  an 
ointment.  Tlic  Liniiuunt  of  Aconite  may  be  substituted  for  the  JJelladonna,  if  de- 
sired. 

In  painful  chronic  tumors,  neuralgia,  «fcc. 

308.  Iodine  and  Cod-Liver  Oil  Ointment. 

R.  Unguenti  lodi  Compositi,  Olci  Morrhua?,  aa  fl.  drs.  iv.     Mix. 

Useful  wlien  rubbed  upon  the  throat  in  bronchocele ;  as  well  as  when  applied  to 
strumous  glands,  unsuppurating  buboes,  and  the  tumid  bellies  of  children  with  mesen- 
teric disease. 

309.  Bole  Armeniack  and  Lead. 

R,  Boli  Armense  Kubrse,  Plumbi  Oxidi  Semivitrei,  aa  gr.  30;  Camphorro,  gr.  5; 
Cer;o  Flavaj,  gr.  180;  Adipis  Pr:eparati,  gr.  3G0.     Mix.     To  be  spread  on  thick  linen. 

Keveral  German  physicians  speak  of  this  as  an  efficacious  apjilication  for  preventing 
and  curing  bed-sores. 

310.  Iodide  of  Sulphur  Ointments. 

R.  Sulphuris  lodidi,  gr.  20;  Unguenti  Simplicis,  oz.  1.     Mix. 
In  acne,  applied  thrice  daily. 

R.  Sulphuris  lodidi,  gr.  12;  Sulphuris  Prscipitati,  gr.  20;  Olei  Amygdalie  Amai-£e, 
min.  V  ;  Adipis  Prajparati,  oz.  1.     Mix. 

311.   Creasote  and  /Sulphur  Ointment. 

R.  Unguenti  Creasoti,  Unguenti  Sulphuris,  aa  oz.  ^.     Mix. 
In  pityriasis,  and  some  other  chronic  cutaneous  aifections. 

312.  Iodide  of  Cadmium  Ointment. 

R.  Cadmii  lodidi,  gr.  60;  Adipis  Prajparati,  oz.  1;  Linimenti  Aconiti  fl.  drs.  iss. 
Mix. 

Superior  to  iodide  of  iwtassium  ointment  for  rubbing  into  tender  and  enlarged 
strumous  glands,  nodes,  &c. 


XIV.  NARCOTICS  AND  SEDATIVES. 

313.  Anoesthetics. 

The  chief  anaesthetics  which  have  hitherto  been  used  in  the  practice  of  medicine  are 
chloroform,  sulphuric  ether,  and  amylene.  As  the  emploj'ment  of  one  or  other  of 
these  agents  is  often  indicated  in  neuralgia,  delirium,  convulsions,  the  paroxysmal 
dyspncea  of  infantile  laryngismus  and  diphtheria  and  croup,  as  well  as  in  spasmodic 
diseases  generally,  a  few  words  on  their  mode  of  administration  may  ziot  be  out  of 
place. 

The  principal  advantages  of  inhalation  are  these :  That  by  means  of  the  immense 
surface  ottered  by  the  air-cells  of  the  lungs  for  absorption,  a  deeper  and  more  rapid 
ottect  is  induced  than  it  would  be  safe  or  easy  to  eff"ect  by  other  means.  At  the  same 
time,  the  digestive  functions  are  less  interfered  with  than  when  narcotics  are  given  in 
the  ordinary  way. 

In  every  form  of  inhalation  the  anajsthetic  should  be  freely  diluted  with  common 
air,  and  no  attempt  made  to  produce  rapid  narcotism  ;  while  the  breathing  ought  to  be 
allowed  to  go  on  quietly  and  naturally.  The  patient  should  be  tranquil, "fearless,  and 
usually  in  the  recumbent  posture.  And  the  administrator  of  the  narcotic  agent,  while 
watching  the  respiration  and  the  countenance,  had  better  also  keep  his  linger  on  the 
pulse.  For  if  the  breathing  becomes  stertorous,  or  if  there  is  evidence  that  the  circu- 
lation is  getting  weak  and  faltering,  the  inhalation  must  be  suspended. 


336  APPENDIX    OF    FORMULA. 

Chloroform  was  introduced  into  practice  by  Sir  James  T.  Simpson,  of  Edinburgh  i 
in  November,  1847.  The  vapor  of  this  hot,  sweet,  heavy  liquid,  may  be  inhaled  by 
individuals  of  all  ages,  from  infants  under  one  year  to  persons  as  old  as  ninety ;  and 
in  almost  all  states  of  the  system.  The  exceptional  cases  which  preclude  its  employ- 
ment, at  all  events  in  medical  practice,  are  instances  of  marked  blood  poisoning,  of 
far-advanced  cardiac  or  pulmonary  or  cerebral  disease,  and  perhaps  of  habitual  drunk- 
enness. It  is  best  administered  from  an  apparatus  such  as  the  late  Dr.  Snow  recom- 
mended ;  though  Sir  James  Simpson  always  uses  a  simple  napkin  folded  into  the  shape 
of  a  funnel.  A  crumpled  handkerchief  in  a  tumbler  forms  a  convenient  inhaler.  But 
in  whatever  way  it  is  exhibited  care  must  be  taken  that  it  does  not  come  into  contact 
with  the  lips  and  nose ;  since  it  produces  painful  excoriations.  Chloroform  should  also 
be  given  slowly  and  cautiously;  and  it  acts  best  before  breakfast,  or  when  the  patient's 
stomach  is  empty.  If  administered  immediately  after  food,  sickness  is  sure  to  result. 
According  to  Dr.  Snow,  about  four  cubic  inches  of  vapor,  or  rather  more  than  live 
grains  of  chloroform  to  each  hundred  cubic  inches  of  air,  is  the  proportion  most  suit- 
able for  causing  insensibility  to  surgical  operations  ;  while  in  medical  and  obstetric 
cases  it  should  only  be  used  in  a  more  diluted  form. — When  an  overdoSe  has  been 
given,  the  patient  should  be  made  to  inhale  ether,  as  it  counteracts  the  depressing 
action  which  chloroform  exerts  on  the  heart.  Or  artificial  respiration,  performed  in 
the  manner  to  be  presently  described,  may  be  resorted  to ;  the  success  of  which  will 
depend  upon  the  extent  to  which  the  heart  and  the  muscles  of  respiration  have  been 
paralyzed  by  the  chloroform.  Dr.  Snow  gave  this  anajsthetic  in  four  thousand  or  more 
cases,  with  the  loss  of  only  one  person  while  inhaling  it;  and  amongst  these  were 
patients  with  heart  disease,  phthisis,  and  several  who  had  suffered  from  apoplexy.  It 
has  been  computed  that  during  the  Crimean  war  chloroform  was  administered  forty 
thousand  times,  death  resulting  in  only  one  case. 

^ther  (first  used  as  an  anaesthetic  in  September,  1846,  by  Dr.  W.  T.  G.  Morton,  of 
Boston,  Massachusetts),  is  thought  to  be  a  safer  agent  for  inducing  narcotism  than 
chloroform  ;  but  although  it  is  so,  still  it  must  be  given  with  the  same  caution.  About 
one  fiuid  ounce  is  usually  inhaled  by  an  adult  in  becoming  insensible ;  though  not 
more  than  half  this  quantity  is  absorbed,  the  remainder  being  thrown  back  from  the 
lungs,  mouth.  Sec.  An  excellent  anaesthetic  for  obstetric  practice  may  be  made  with 
equal  parts  of  ether  and  chloroform. 

Aniylene  is  made  by  distilling  amylic  alcohol  (obtained  from  crude  fusel  oil,  or  oil  of 
potato  spirit)  with  chloride  of  zinc.  In  the  present  state  of  our  knowledge,  it  is  not 
advisable  to  resort  to  this  agent.  Dr.  Snow  seems  to  have  administered  it  in  238  cases, 
and  to  have  had  two  deaths  from  it. 

In  apparent  death  from  any  anesthetic,  artificial  respiration,  after  the  plan  recom- 
mended by  Dr.  Silvester,  ought  to  be  tried.  The  body  is  to  be  laid  on  its  back  with 
the  head  and  shoulders  slightly  raised.  The  mouth  and  nostrils  are  to  be  cleansed  from 
mucus  ;  and  the  tongue  should  be  drawn  firmly  forwards  so  as  to  keep  the  tip  well 
protruded  at  the  side  of  the  mouth.  Then  the  operator  is  to  compress,  for  two  or  three 
seconds,  the  front  and  sides  of  the  chest  by  the  patient's  own  arms.  Thus  the  medi- 
cated vapor  will  be  partly  expelled  from  the  lungs;  while  upon  the  pressure  being 
suddenljr  removed,  the  elastic  walls  of  the  chest  will  expand,  and  give  the  primary 
impetus  to  respiration.  To  assist  expansion  to  the  utmost,  the  ribs  should  be  drawn 
upwards  by  means  of  the  pectoral  muscles.  This  is  effected  by  the  operator  grasping 
the  arms  just  above  the  elbows,  and  drawing  them  upwai'ds  until  the}'  nearly  meet 
above  the  head.  Then  they  must  be  lowered,  and  replaced  at  the  sides;  at  the  same 
time  making  moderate  pressure  with  them,  for  a  couple  of  seconds,  against  the  chest- 
walls.     This  process  is  to  be  repeated  fifteen  times  in  the  minute. 

In  some  instances,  galvanism  of  the  phrenic  nerve,  diaphragm,  and  intercostal 
muscles  would  be  useful  in  keeping  up  the  movements  of  respiration;  one  pole  of  the 
battery  being  applied  over  the  outer  edge  of  the  sterno-mastoid  muscle  just  above  the 
clavicle,  while  the  other  is  pressed  deeply  into  the  seventh  intercostal  space.  The 
diaphragm  must  be  made  to  contract  and  relax  alternately,  by  interrupting  the  cur- 
rents at  equal  intervals. 

"Wiule  attempts  are  thus  being  made  to  oxygenate  the  blood,  an  assistant  is  to  rub  the 
limbs  I'rom  the  extremities  towards  the  heart.  If  no  resjiiratoiy  efibrts  supervene,  the 
face  and  chest  are  to  be  daslied  with  cold  water,  or  with  hot  and  cold  water  alter- 
nately. "When  success  folh^ws  this  plaii,  the  temperature  of  the  body  must  be  main- 
tained by  friction,  hot  blankets,  the  warm  bath,  cV:c. 

314.  3Ior2)hia,  Atropine^  Aconitine,  ^c.,for  Hypodermic  Injection. 

The  solution  of  Acetate  of  Morphia  as  used  for  injection  under  the  skin  is  generally 
made  by  mixing  ten  grains  of  this  salt  with  onedraclim  of  distilled  water.  Suthcient 
acetic  acid  is  then  added  to  dissolve  the  morphia ;  the  fluid  being  afterwards  neutral- 


NARCOTICS   AND    SEDATIVES.  837 

izod  by  the  addition  of  Liquor  Potassae  until  a  cloud  appoars.     Finally,  one  or  two 
drops  of  acetic  acid  are  u.scd  to  gently  acidulate  the  mixture. 

Each  six  minims  of  this  solution  will  contain  one  grain  of  acetate  of  morphia.  For 
first  injections,  not  more  than  one  minim  and  a  half  should  be  used  ;  as  it  is  certain 
that  this  narcotic  acts  more  jiowerfully  when  thus  employed,  than  when  taken  into 
the  stomach.  In  diseases  which  are  continuf)usly  painful  the  ease  given  by  an  injec- 
tion will  last  for  about  twelve  hours.  To  relieve  the  suffering  of  advanced  cancer,  ice, 
tile  injection  may  be  advantageously  given,  night  and  morning,  for  many  months. 

The  subcutaneous  injection  of  Atropine  is  sometimes  useful  in  cases  of  intestinal 
obstruction,  asthma,  tetanus,  neuralgia,  chorea  in  the  adult,  &c.  Great  caution  is 
necessary  :  not  more  than  two  minims  of  the  officinal  Liquor  Atropia?  (  =  to  gr.  1-50) 
should  be  employed  at  first. 

Chloroform  n~iay  be  used  in  same  manner.  The  injection  of  ten  or  fifteen  minims 
often  efiects  a  cure  for  the  time  in  pleurodynia,  neuralgia,  sciatica,  &c.  It  has  the 
disadvantage  of  sometimes  producing  an  irritable  ulcer,  which  may  be  slow  in  healing. 

A  solution  of  Aconitlne  maybe  made  thus:  Aconiti^,  gr.  1;  Spiritfis  Kectificati, 
min.  x;  Aquse  Destillatie,  ad  ti.  drs.  ij.  Mix.  For  first  injections  not  more  than  two 
minims  should  be  employed  :  the  dose  may  afterwards  be  safely  increased  to  four 
minims  (gr.  1-30).  It  is  better,  though  not  absolutely  necessary,  to  make  the  injec- 
tion at  the  seat  of  j^ain. 

315.  3Iorphia  Draughts,  ^^c. 

R.  Liquoris  Morphise  Hydrochloratis,  min.  xxx  (=  to  gr.  \  of  the  salt) ;  Syrupi 
Limonis,  fl.  drm.  j  ;  Aqute'Oamphora;,  fl.  oz.  j.     Mix.     To  be  taken  at  bedtime. 
In  insomnia  with  pain. 

R.  Liquoris  Morphise  Hj^drochloratis,  min.  xv — xxx;  Spiritus  Chloroformi,  fl. 
drm.  j  (=to  min.  iij  of  chloroform);  Spiritus  ^Etheris,  min.  xxx;  Tinctura;  Bella- 
donnoe,  min.  xx ;  Tincturaa  Cardamomi  Compositis,  fl.  drm.  j  ;  Aquae,  ad  fl.  oz.  iss. 
Mix.     To  be  taken  every  two  hours  (the  patient  being  watched)  until  the  pain  ceases. 

Useful  in  facilitating  the  passage  of  gall-stones. 

R.  Liquoris  Morphise  Hydrochloratis,  min.  xl ;  Acidi  Hydrocyanici  Diluti,  min. 
XX ;  Syrupi  Scillse,  fl.  drs.  vj  ;  Mucilaginis  Acacite,  ad  fl.  oz.  vj.  Mix.  One  table- 
spoonful  every  three  or  four  hours. 

In  many  irritable  coughs. 

316.   Chloroform  and  Opium. 

R.   Chloroformi,  min.  X — xv  ;  Extracti  Opii  Liquidi,  min.  xv — xxx;  Syrupi  Rhoea- 
dos,  fl.  drm.  j  ;  Mucilaginis  Tragacanthie,  fl.  oz.  j.     Mix,  for  a  night  draught. 
In  severe  colic  and  other  spasmodic  disorders. 

317.  Morphia,  Chloroform,  and  Indian  Hemp. 

R.  Liquoris  Morphite  Hydrochloratis,  min.  xx ;  Chloroformi,  min.  x;  Tincturje 
Cannabis  Indicfe,  min.  xx  ;  Pulveris  Tragacanthffi  Compositi,  gr  30;  Spiritiis  ^theris, 
min.  xl  ;  Acidi  Hydrocyanici  Diluti,  min.  iv  ;  Aquae,  ad  fl.  oz.  iss.  Mix,  for  a  night 
draught. 

In  many  chronic  diseases  attended  with  pain  or  restlessness. 

The  medicine  called  Chlorodyne  probably  consists  essentially  of  chloroform,  In- 
dian hemp,  morphia,  and  hj'drocyanicacid.  In  the  Canada  Lancet  (15th  October,  1864) 
Dr.  W.  E.  Bowman  gives  the  following  formula  for  its  preparation  :  Take  of  Chloro- 
form, half  a  fluid  ounce ;  Sulphuric  Ether,  ninety  minims ;  Oil  of  Peppermint,  eight 
drops;  Kesin  of  Indian  Hemp,  six  grains;  Capsicum,  two  grains.  Mix,  shake  occa- 
sionally, and  allow  it  to  stand  for  a  few  days.  Take  of  Muriate  of  Morphia,  sixteen 
grains,  dissolved  by  the  aid  of  heat  in  two  fluid  drachms  of  water;  to  which  when 
cold,  add  of  Scheele's  Hydrocyanic  Acid,  sixty-five  minims ;  Perchloric  Acid,  one 
fluid  drachm  ;  Treacle,  two  fluid  ounces.  Add  this  gradually  to  the  first  mixture,  and 
then  make  the  whole  measure  four  fluid  ounces  by  the  addition  of  treacle  or  water. — 
Each,  dose  of  thirty  minims  contains  of  chloroform  min.  iv,  ether  min.  iss,  extract  of 
hemp,  gr.  1-lOth,  hydrochlorate  of  morphia,  gr.  \,  and  of  Scheele's  acid  min.  j. 

22 


338  APPENDIX    OF   FORMULA. 


318.  Brandy  and  Egg  Mixture,  with  Opium. 

R.  Misturpe  Spiritus  Yini  Gallici  (see  F.  17)  fl.  oz.  j  ;  Extracti  Opii  Liquid!  min. 
Y — x;  Spiritus  Chloroformi,  min.  xl.     Mix.     To  be  taken  every  four  hours. 
In  exhaustion  from  pain. 

319.  Tolu  and  Camphorated  Opium. 

R.  Tincturse  Tolutanffi,  fl.  drs.  ij  ;  Syrupi  Tolutani,  fl.  oz.  j  ;  Tincturas  Camphorse 
cum  Opio,  fl.  drs.  iv  (=  to  gr.  1  of  opium) ;  Mucilaginis  Tragacanthse,  ad  fl.  oz.  viij. 
Mix.     Two  tablespoonfuls  three  times  a  day. 

For  old  people,  where  the  mucous  secretion  from  the  bronchi  is  excessive. 

320.  Cimicifuga  Macemosa,  or  Black  Snake-root. 

R.  Tincture  Acteae  Eacemosaj,  min.  xxx — fl.  drs.  ij  ;  Aquae,  ad  fl.  oz.  j.  Mix,  for 
a  draught.  To  be  administered  every  three  or  four  hours  until  nausea  ensues  or  the 
pulse  becomes  lowered. 

This  drug  possesses  narcotic  and  eliminative  properties,  and  is  useful  in  chronic 
rheumatism,  lumbago,  chorea,  obscure  nervous  pains,  and  in  backache  from  uterine 
disturbance. 

321.  American  Hellebore. 

R.  Tincturffi  Yeratri  Yiridis  (a  saturated  solution),  min.  v — x ;  Aquae,  fl.  oz.  j. 
Mix.  This  draught  may  be  given  every  three  hours,  adding  one  drop  of  tincture  to 
each  dose,  until  the  pulse  becomes  sufficiently  lowered,  or  nausea  is  produced.  The 
latter  is  readily  counteracted  by  small  doses  of  morphia. 

It  is  a  valuable  arterial  sedative  ;  and  is  particularly  used  by  American  physicians 
in  inflammations  of  the  lungs,  pleura,  or  peritoneum,  and  in  acute  rheumatism. 

322.  Lobelia  and  Ether. 

R.  Spiritfis  Ammonise  Aromatici,  fl.  drs.  ij  ;  Tincturae  Lobeliae  ^therae,  fl.  drs.  iij 
— vj  ;  Tincturaj  Aconiti,  min.  xxx  ;  Aquae  Camphors,  ad  fl.  oz.  viij.  Mix.  One- 
sixth  part  twice  or  thrice  daily. 

As  a  sedative  in  some  cases  of  asthma. 

323.   Stramonium  and  Henbane. 

R.  Extracti  Stramonii,  gr.  3;  Extracti  Hyoscyami,  gr.  20;  Extracti  Lupuli,  gr. 
40.  Mix,  and  divide  into  twelve  pills.  One  to  be  taken  every  four  hours  until  relief 
is  obtained. 

In  chronic  disorders  attended  with  suffering,  in  diseases  of  the  nervous  system  ac- 
companied witii  pain  and  restlessness,  and  in  the  dyspncea  of  phthisis  and  emphysema. 

R.  Tincturae  Stramonii,  fl.  drs.  j — ij ;  Tincture  Hyoscyami,  fl.  drs.  ij  ;  Tincturae 
Cantharidis,  fl.  drni.  j  ;  Spirittis  Chloroformi,  fl.  di"s.  iij;  Aquae,  ad  fl.  oz.  viij.  Mix. 
One-sixth  part  three  times  a  day. 

In  some  cases  of  asthma. 

324.  Opium  and  Ipecacuanha. 

R.  Extract!  Opii,  Pulveris  Ipecacuanhae,  aa  gr.  1;  Potassae  Nitratis,  gr.  8;  Gly- 
cerini,  sufficient  to  make  a  mass.  Divide  into  two  pills,  and  order  them  to  be  taken 
at  bedtime. 

A  good  narcotic  and  diaphoretic.  It  is  preferable  to  the  officinal  Powder  op 
IPECAC0AN  AND  Opium,  as  the  nitrate  of  potash  acts  better  than  the  sulphate. 

R.  Yini  Ipecacuanh;e,  fl.  drs.  iiss  ;  Extracti  Opii  Liquidi,  min.  xxx;  Syrupi  Tolu- 
tani, fl.  drs.  v;  Mucilaginis  Tragacanthae,  fl.  oz.  j.  Mix.  One  teaspoonful  every 
two  or  three  hours. 

In  chronic  cough. 


NARCOTICS    AND    SEDATIVES.  339 


325.  Henbane,  Camphor,  and  Hop. 

R.  Extracti  Hyoscyami,  Caiiijiliora',  Lu])ulinie,  aa  gr.  20.  Mix,  divide  into  twelve 
pilLs,  and  order  two  to  bo  tak(!n  every  niglit  at  bedtime. 

An  excellent  sedative  for  hysterical  and  hypochondriacal  patients  suflering  from 
sleeplessness. 

R.  Spiritfls  Camphorae,  min.  xxx ;  Tinctimc  liyosoyami,  Tinctnrm  Lu]iuli,  aa  fl. 
drm.  j  ;  Mucilaginis  Acacitu,  11.  oz.  j.     Mix,  for  a  draught  to  be  taken  at  bedtime, 

326.  Belladonna.     Atropia. 

R.  Extracti  Belladonnas,  gr.  5  ;  Zinci  Sulphatis,  gr.  30;  Extracti  Gentianse,  gr.  90. 
Make  a  mass,  divide  into  twenty  pills,  and  order  one  to  be  taken  three  times  a  day. 

In  cases  where  a  sedative  and  tonic  action  is  to  be  produced.  Especially  useful  in 
some  diseases  attended  with  irritability  of  the  urinary  organs.  Also  in  many  spas- 
modic coughs.     See  F.  92. 

R.  Extracti  Belladonnas,  gr.  \  ;  Extracti  Quassia?,  gr.  2.  Mix  into  a  pill,  to  be 
taken  night  and  morning. 

In  epilepsy.     Eequires  to  be  given  for  a  long  period. 

R.  Camphoras,  gr.  5;  Extracti  Belladonnse,  gr.  J;  Extracti  Conii,  gr.  4;  Spiritus 
Kectificati,  sufficient  to  make  two  pills.     To  be  taken  every  night  at  bedtime. 

In  spermatorrhoea ;  convulsions ;  as  well  as  in  certain  spasmodic  atfections  of  the 
air-passages. 

R.  Liquoris  Atropia?,  fl.  drs.  ij.  One  drop  (=gr.  1-120)  in  a  tablespoonful  of 
brandy  and  water,  night  and  morning. 

In  epilepsy.  The  dose  to  be  increased  by  one  drop  every  second  or  third  week.  A 
preparation  of  zinc  may  be  given  at  the  same  time,  if  desired. 

327.  Camphor  and  Blue  Pill. 

R.  Camphorse,  gr.  5  ;  Extracti  Opii,  gr.  1 ;  Pilulje  Hydrargyri,  gr.  4.  Mix,  divide 
into  two  pills,  and  order  them  to  be  taken  at  bedtime. 

In  restlessness  with  congestion  of  the  liver  and  irritability  of  the  sexual  organs. 
Also  in  venereal  sores  with  nocturnal  emissions. 

328.  Codeia  and  Assafmtida, 

R.  Codeia,  gr.  J;  Pilulte  Assafcetida?  Composita^,  gr.  5.  Mix  into  a  pill,  to  be 
taken  every  night  at  bedtime. 

Especially  useful  in  attacks  of  spasmodic  cough,  dyspnoea,  .&c. 

329.  Morphia  and  Assafoetida. 

R.  Morphine  Hydrochloratis,  gr.  2;  Assafoetida?,  gr.  30;  Camphoris,  gr.  20.     Make 
a  mass,  divide  into  twelve  jiills,  and  order  one  to  be  taken  at  bedtime. 
A  good  stimulant  and  antispasmodic. 

330.  Aconite  and  diaiacum. 

R.  Tincturae  Aconiti,  min.  xx — xl  ;  Spiritus  ^Etheris,  fl.  drs.  iv  ;  Misturae  Guaiaci, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

As  an  anodyne,  stimulant,  and  alterative  in  chronic  rheumatism,  neuralgia,  «S:c. 

331.  Aconite  and  Mercury. 

R.  Extracti  Aconiti,  gr.  1—3;  Pilulae  Calomelanos  Compositaj,  gr.  3.     Make  into 
a  pill,  and  order  it  to  be  taken  every  night  at  bedtime. 
In  sleeplessness  from  a  syphilitic  taint. 

332.  Aconite  and  Opium. 

R.   Extracti  Aconiti,  Extracti  Opii,  aa  gr.  8;  Extracti  Hyoscyami,  gr.  IG.     Mix, 
and  divide  into  eight  pills.     One  to  be  taken  every  four,  six,  or  eight  hours. 
In  some  acute  inflammations, — as  peritonitis,  pleurisy,  ovaritis,  &c. 


340  APPENDIX    OF   FORMULA. 


333.   Opium  and  Sugar  of  3Iilk. 

R.  Pulveri?  Ipecacuanhse  cum  Opio,  gr.  1  ;  Sacchari  Lactis,  gr.  120.  Mix,  and 
divide  into  four  powders.  One  to  be  taken  every  night,  beaten  up  in  a  teaspoonful  of 
cream. 

A  safe  opiate  for  infants  from  two  to  six  weeks  old. 

R.  Tincture  Opii,  min.  j  ;  Sacchari  Lactis,  oz.  ^  ;  Mucilaginis  Tragacantbse,  Aquse 
Anethi,  aa  fl.  drs.  iv.  JVlix.  One  teaspoonful  twice  or  thrice  in  the  twenty-four 
hours. 

In  the  painful  diseases  of  early  life. 

334.   Tincture  of  Digitalis. 

R.  Tincturae  Digitalis,  fl.  drm.  j  ;  Aqua?  Anethi,  fl.  oz.  viij.  Mix.  One-sixth  part 
every  four  hours. 

Recent  experiments  tend  to  prove  that  digitalis  is  a  cardiac  stimulant  and  tonic ; 
and  that  it  is  therefore  especially  useful  in  diseases  due  to  weakness  of  the  muscular 
■walls. 

R.  Tincture  Digitalis,  fl.  drs.  j — ij  ;  Tincturse  Cardamomi  Composita3,  fl.  drs.  vj  ; 
Acidi  Hydrocyanici  Diluti,  min.  xx  ;  Aquae  Camphoraj,  ad  fl.  oz.  viij.  Mix.  One- 
sixth  part  three  times  a  day. 

In  some  forms  of  cardiac  disease,  with  irritability  of  the  stomach. 

R.  Acidi  Sulphurici  Aromatici,  fl.  drs.  ij  ;  Tincturae  Digitalis,  fl.  drm.  j  ;  Extracti 
Opii  Liquidi,  min.  xxx  ;  Infusi  Chiratte,  ad  fl.  oz.  viij.  5lix.  One-sixth  part  three 
times  a  day.  p 

335.  Hemlock  and  JTenbane,  ^c. 

R.  Extracti  Conii,  Extracti  Hyoscyami,  Pilulae  Ehei  Compositae,  aa  gr.  3.  Mix, 
and  divide  into  two  pills.     To  be  taken  at  bedtime. 

To  relieve  sleeplessness  with  constipation.     In  some  forms  of  asthma. 

R.  Extracti  Conii,  Extracti  Hyoscyami,  Pilulae  Hydrargyri,  aa  gr.  3;  Pulveris 
Ipecacuanhas,  gr.  1.     Mix,  and  divide  into  two  pills.     To  be  taken  at  bedtime. 

336.  Hemloch  and  Dover's  Powder. 

R.   Extracti  Conii,  gr.  36;  Pulveris  Ipecacuanhae  cum  Opio,  gr.  24.     Mix,  and 
divide  into  twelve  pills.     One  to  be  taken  every  three  or  four  hours. 
To  relieve  the  pain  arising  from  malignant  disease. 

337.  Henbane  and  Indian  Hemp. 

R.  Extracti  Cannabis  Indicae,  gr.  \ — 1;  Extracti  Hyoscyami,  gr.  4.  Make  into  a 
piU.     To  be  taken  every  twelve  or  twenty-four  hours. 

338.  Iodoform  Pills  and  Suppositories. 

R.  lodoformi,  gr.  2—6;  Extracti  Conii,  gr.  4.  Mix.  Divide  into  two  pills,  and 
order  them  to  be  taken  at  bedtime. 

In  painful  diseases  of  the  stomach.  The  author  has  once  or  twice  found  a  full 
dose  of  iodoform  relieve  a  paroxysm  of  asthma. 

R.  lodoformi,  gr.  3 — 8;  Butyri  Cacao,  gr.  20.  Mix,  for  a  suppository. 
As  a  local  anaesthetic  in  cancerous  and  odier  painful  diseases  of  rectum. 
The  anodyne  action  of  iodoform  is  uncertain. 

339.   Opiate  Enemata. 

R.  Tincluraj  Opii,  min.  xx — xxx  ;  Vini  Ipecacuanhae,  min.  xxx  ;  Mucilaginis 
Amyli,  fl.  oz.  ij.  Mix.  The  bowel  should  be  washed  out  with  warm  water  before 
the  administration  of  this  enema. 

In  diarrhoea,  tenesmus,  strangury,  &c. 

R.  Extracti  Opii  Liquidi,  min.  xx— fl.  drm.  j  ;  Tincture  Belladonnae,  min.  xv— 
xxx;  Mucilaginis  Amyli,  fl.  oz.  ij.     Mix. 
In  cancer  of  uterus,  rectum,  &c. 


NARCOTICS   AND    SEDATIVES.  341 


340.   Opiate  Suppositories. 

R.  Piilveris  Opii,  gv.  1—2;  Saponis  Diiri,  gv.  10.     Mix,  for  a  suppository. 
To  allay  pain  or  irritation  about  the  pelvic  viscera. 

R.  Extracti  Opii,  gr.  1—3;  Extracti  Belladonna;,  gr.  ^;  Butyri  Cacao,  gr.  20. 
3Iix  into  a  suppository. 

Especially  useful  in  diseases  of  the  bladder  and  rectum. 

341.  Lettuce  Opium. 

R.   Lactucarii,  gr.  8—10.     To  be  divided  into  two  pills,  to  be  taken  at  bedtime. 
A  doubtful  narcotic.     Has  been  chiefly  used  as  an  anodyne  in  phthisis,  or  where 
opium  cannot  be  borne. 

342.  Indian  Hemp,  Aconite,  and  Ether. 

R.  Tincturse  Cannabis  Indicte,  min.  xx ;  Spiritus  .Juniperi,  min.  xxx ;  Spiritiii? 
iEtheris,  min.  xlv  ;  Tincturse  Aconiti,  min.  x  ;  Mucilaginis  Acaciie,  ad  fl.  oz.  iss.  Mix, 
for  a  draught.     To  be  taken  at  bedtime. 

In  neuralgic  dysmenorrhoea,  &c. 

343.  Opium,  or  Morphia,  and  Henbane. 

R.  Extract!  Opii,  gr.  1 — 3,  vel  Morphias  Hydrochloratis,  gr.  \ — 1.  Extracti  Hyos- 
cyami,  gr.  3.  Make  into  a  pill,  to  be  taken  at  bedtime.  For  the  relief  of  severe  pain, 
and  to  afford  sleep  in  lingering  diseases. 

344.  Opium  and  Belladonna. 

R.  Extracti  Opii,  gr.  1 ;  Extracti  Belladonnse,  gr.  J;  Extracti  Conii,  gr.  3.  Make 
into  a  pill,  to  be  taken  every  three  or  four  hours. 

In  intestinal  obstruction  And  in  other  cases  where  it  is  necessary  to  relieve  severe 
pain  without  inducing  constipation. 

The  belladonna  may  be  omitted  where  only  the  influence  of  the  opium  is  required. 

345.  Opium  and  Capsicum. 

R.  Extracti  Opii,  gr.  1 — 2;  Pulveris  Capsici,  gr.  2;  Extracti  Hyoscyami,  gr.  4. 
Make  into  two  pills,  to  be  taken  every  night  at  bedtime. 

In  those  diseases  where  opium  is  needed,  but  where  it  is  not  well  borne,  owing  to 
its  producing  headache,  sickness,  &c.  The  stimulating  eflect  of  the  cajjsicum  will 
often  ward  ofl"  these  unpleasant  results. 

346.  3Iorphia  and  Squill  Linctus. 

R.  Syrupi  Scillaj,  Syrupi  RhcEados,  aa  fl.  oz.  j  ;  Liquoris  Morphia;  Hydrochloratis, 
fl.  drm.  j.  Mix,  and  label, — "A  small  teaspoonful  to  be  taken  frequently,  if  the  cough 
is  troublesome." 

347.    Compound  Linctus. 

R.  Spiritus  Chloroformi,  fl.  drs.  iv  ;  Vini  Ipecacuanhse,  fl.  drs.  ij  ;  Liquoris  Morphiaj 
Hydrochloratis,  fl.  drm.  j  ;  Acidi  Hydrocyanici  Diluti,  min.  xv ;  Syrupi  Mori,  ad  fl. 
oz.  iij.  Mix,  and  label, — "  One  teaspoonful  every  two  or  three  hours,  until  the  cough 
is  relieved." 


342  APPENDIX   OF   FORMULA. 


XV.  REFRIGERANTS  AND  SALINES. 

348.  Saline  Draughts. 

R.  Sodfe  Bicarbonatis,  gr.  20;  Aqua?  Laurocerasi,  min.  x  ;  Syrupi  Limonis,  fl.  drm. 
j  ;  Aquiie,  ad  fl.  oz.  iss.  Mix.  An  efl'ervescing  draught  is  to  be  made  by  the  addition 
of  a  tablespoonful  of  lemon-juice,  or  of  eighteen  grains  of  citric  acid.  To  be  taken 
every  four  or  six  hours. 

In  fever  with  nausea. 

R.  Spiritus  yEtheris  Nitrosi,  fl.  drs.  iv ;  Liquoris  Ammonise  Acetatis,  fl.  drs.  iij — 
V j  ;  Vini  Colchici,  fl.  drm.  j;  Aqute  Camphorte,  ad  fl.  oz.  viij.  Mix.  Two  table- 
spoonfuls  every  four  hours. 

R.  Syrupi  Scillpe,  fl.  drs.  vj  ;  Spiritus  ^theris  Nitrosi,  Tinctura3  Hyoscyami,  aa  fl. 
drs.  iij  ;  Infusi  Rosie  Acidi,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 
In  influenza,  catarrh,  «&;c. 

R.  Potassse  Nitratis,  gr.  40,  vel  Potassae  Citratis,  gr.  100 ;  Vini  Antimoniale,  fl. 
drm.  j  ;  Liquoris  Ammonife  Acetatis,  fl.  drs.  iv ;  Aqu«  Camphorse,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  every  four  hours. 

349.  Saline  with  Excess  of  Ammonia. 

R.  Liquoris  Ammonife  Acetatis,  fl.  drs.  vj  ;  Spiritus  Ammonias  Aromatici,  fl.  drs. 
iij  ;  Syrupi  Liraonis,  fl.  drs.  vj  ;  Aquae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  every 
four  hours. 

In  the  early  stages  of  fever,  tonsillitis,  &G. 

350.  Dr.  Stevens's  Saline  Mixture. 

R.   Sodii  Chloridi,  gr.  20;   Potassre  Chloratis,   gr.   7;   Sodse   Carbonatis,  gr.  30; 
Aquise,  fl.  oz.  iss.     Mix.     To  be  taken  every  half  hour. 
In  malignant  cholera. 

351.   Colehieum  and  Magnesia. 

R.  Vini  Colchici,  fl.  drs.  iss;  Magnesia?  Carbonatis,  gr.  120;  Spiritfts  Ammonise 
Aromatici,  fl.  drs.  iij  ;  Tincturte  Hyoscyami,  fl.  drs.  ij  ;  Aquae  Camphorse,  ad  fl.  oz. 
viij.     Mix.     One-sixth  part  night  and  morning. 

In  slight  cases  of  gout,  &c. 

352.   Colehieum  and  Chlorate  of  Potash. 

R.  Vini  Colchici,  fl.  drs.  ij  ;  Potassae  Chloratis,  gr.  120;  Liquoris  Ammonise  Ace- 
tatis, fl.  drs.  vj  ;  Aquaj  Camphorse,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times 
a  day. 

In  gout  with  heat  and  dryness  of  the  skin. 

353.  Borax  and  Nitric  Ether. 

R.  Boracis,  gr.  80;  Spiritus  ^theris  Nitrosi,  fl.  drs.  iij  ;  Syrupi  Papaveris,  fl.  drs. 
vj  ;  Infusi  Lini,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

354.  Ammonia,  Chlorinated  Soda,  and  Serpentary. 

R.  Ammonise  Carbonatis,  gr.  30;  Liquoris  Sodse  Chloratse,  fl.  drm.  j  ;  Infusi  Ser- 
pentariic,  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

As  a  diaphoretic  and  stimulant  in  the  low  stage  of  continued  fever.     See  P.  368. 

355.  Bicarbonate  of  Potash  Drink. 

R.  Potassae  Bicarbonatis,  oz.  \ — ^  ;  Syrupi  Limonis,  fl.  oz.  j  ;  Aquse,  ad  Oij.  Mix, 
for  the  day's  drink. 

Very  useful  in  the  uric  acid  diathesis,  in  acute  rheumatism,  &c.  A  drink  called 
"Constitution-water"  owes  its  efficacy  to  the  bicarbonate  of  potash  it  contains. 


STIMULANTS.  343 


35G.   Cream  of  Tartar  Drink. 

R.  Potassse  Tartratis  Acidse,  oz.  1;  Olei  Limonis,  min.  xv ;  Sacchari  Albi,  oz.  2; 
Aqua}  Bulliontis,  Oij.     Mix.     To  be  used,  when  cold,  as  a  common  drink. 
In  simple  fever,  with  constipation  and  great  thirst. 

357.  Hydrochloric  Acid  Drink. 

R.   Acidi  Hydrochlorici   Diluti,  fl.   drs.  ij — iij  ;   Mellis  Depurati,  oz.  1;   Decocti 
Hordoi,  Oij.     Mix,  for  the  daily  drink. 
In  typhus,  «&c. 

358.  Hydrochloric  Acid  and  Chlorate  of  Potash  Drink. 

R.  Acidi  Hydroehlorici  Diluti,  fl.  drs.  ij  ;  Potassce  Chloratis,  gr.  180;  Syrupi  Zin- 
gibcris,  fl.  oz.  j  ;   Decocti  Hordei,  Oij.     Mix. 
A  valuable  drink  in  some  cases  of  fever. 

359.  Phosphoric  Acid  Drink. 

R.  Acidi  Phosphorici  Diluti,  fl.  drs.  iij  ;  Glycerini,  fl.  oz.  j  ;  Decocti  Hordei,  Oij. 
Mix. 

An  efficacious  drink  for  assuaging  thirst  in  some  diseases  attended  with  nervous 
exhaustion.  It  was  recommended  by  Dr.  Paris  and  Sir  Thomas  Watson  as  useful  in 
diabetes ;  but  according  to  Griesinger  it  positively  increases  the  quantity  of  sugar 
excreted. 

360.   Chlorate  of  Potash  Drinks.  "^ 

R.  Potassae  Chloratis,  gr.  60;  Syrupi  Hemidesmi,  fl.  oz.  j  ;  Aqufe,  Oj.     Mix. 
In  the  eruptive  fevers,  some  inflammations,  &c. 

R.  Potassa?  Chloratis,  oz.  1  ;  Potassse  Bicarbonatis,  oz.  2 — 4.     Mix,  and  divide  into 
eight  powders.     One  to  be  dissolved  in  a  pint  of  barley-water  for  the  day's  drink. 
In  acute  rheumatism. 


XVI.  STIMULANTS. 

361.  Ammonia  and  Bitters. 

R.  Ammonise  Carbonatis,  gr.  30;  Spiritiis  Myristicae,  fl.  drs.  ij ;  Tincturse  Carda- 
momi  Compositse,  fl.  drs.  vj  ;  Infusi  Caryophylli,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  every  four  or  six  hours. 

In  debility  with  nausea  and  flatulence.  Also  in  erysipelas,  tonsillitis,  scarlet 
fever,  &c. 

R.  Spiritus  Ammonise  Aromatici,  fl.  drs.  iij  ;  Tincturae  Lupuli,  fl.  drs.  vj  ;  Tinc- 
tur£e  Gentians  Compositae,  fl.  oz.  j  :  Infusi  Sennae,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  twice  or  thrice  daily. 

In  phosphuria  with  constipation. 

R.  Spiritus  Ammonire  Aromatici,  fl.  drs.  iij  ;  Aquae  Laurocerasi,  fl.  drm.  j  ;  Sodae 
Bicarbonatis,  gr.  60;  Tinoturre  Calumbie,  fl.  drs.  vj  ;  Aquae  Anethi,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  two  or  three  times  a  day. 

To  relieve  nausea,  or  vomiting,  with  heartburn. 

362.  Ammonia  in  Effervescence. 

R.  Ammonia  Carbonatis,  gr.  120;  Acidi  Hydrocyanici  Diluti,  min.  xx;  Tincturae 
Cardamomi  Composita^,  fl.  drs.  vj  ;  Infusi  Aurantii,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  to  be  made  into  an  eftervesc'ing  draught  with  one  tablespoonful  of  fresh  lemon- 
juice,  or  with  eighteen  grains  of  citric  acid.     To  be  taken  twice  or  thrice  daily. 

In  irritability  of  the  stomach,  with  depression. 


344  APPENDIX    OF    FORMULA. 

R.  Spiritus  Ammoniffi  Aromatici,  fl.  drs.  iv  ;  Potassa;  Bicarbonati?,  gr.  120 ;  Spiritus 
Chloroformi,  fl.  drs.  iij  ;  Tincturaj  Hyoscyami,  fl.  drs.  iij  ;  Infusi  Cascarilla?,  ad  fl.  oz. 
viij.  Mix.  One-sixth  part  every  four  hours,  made  into  an  etJervescing  draught  with 
one  tablespoonful  of  lemon-juice. 

In  irritable  stomach  with  undue  acidity  of  the  secretions. 

363.  Ammonia,  Valerian,  and  Rhubarb. 

R.  Tincturae  Yalerianas  Ammoniatse,  fl.  drs.  iij  ;  Tincturse  Ehei,  fl.  drs.  vj  ;  Tinc- 
ture Lavandula;  Compositse,  fl.  oz.  j  ;  Aqua;  Pimentae,  fl.  oz.  viij.  Mix.  One-sixth 
part  when  oppressed  with  languor  or  faiutness. 

In  hypochondriasis  and  hysteria. 

364.  Ammonia  and  Ether. 

R.  Ammonia;  Carbonatis,  gr.  30;  Spiritus  JEtheris,  fl.  drs.  iij  ;  Infusi  Caryophylli, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 
In  debility  with  flatulence. 

365.  Hydrochloric  Acid  a7id  Ether. 

R.  Acidi  Hydrochlorici  Diluti,  fl.  drm.  j  ;  Spiritus  ^theris,  fl.  drs.  iij  ;  Syrupi 
Aurantii,  fl.  drs.  vj  ;  Infusi  Aurantii,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  every  six 
hours. 

In  continued  fever,  and  in  cases  where  the  respired  air  is  ammoniacal. 

366.    Cajuput  Oil  and  Cloves. 

R.  Olei  Cajuputi,  min.  v;  Pulveris  Tragacanthte  Compositi,  gr.  60;  Aquae  Destil- 
latee,  fl.  drs.  ij.  Beat  thoroughly  together,  and  add — Infusi  Caryophylli,  fl.  drs.  x. 
Mix.     To  be  taken  occasionally. 

In  hysteria,  flatulent  colic,  and  many  spasmodic  diseases. 

R.  Olei  Cajuputi,  min.  iv  ;  Sacchari  Lactis,  gr.  120.  Beat  up  thoroughly,  and  add — 
Decocti  Aloes  Compositi,  fl.  oz.  iss.  Mix.  To  be  taken  occasionally,  early  in  the 
morning. 

As  a  stimulant  and  laxative,  where  there  is  a  tendency  to  flatulence  and  a  loaded 
rectum. 

367.  Ether  and  Brandy. 

R.  Spiritus  JEtheris,  fl.  drs.  iij  ;  Spiritus  Vini  Gallici,  fl.  drs.  xij  ;  Infusi  Cinchonae 
Flavje,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  four  or  six  hours. 
At  the  commencement  of  convalescence  from  many  acute  diseases. 

R.  Spiritus  Chloroformi,  fl.  drs.  vj  ;  Misturae  Spiritus  Vini  Gallici  (F.  17),  fl.  oz. 
viij.     Mix.     One-sixth  part  every  six  hours. 
In  the  low  stages  of  fever  with  restlessness. 

368.  Solution  of  Chlorinated  Soda. 

R.  Liquoris  Sodse  Chloratae,  fl.  drs.  i — ij  ;  Syrupi  Tolutani,  fl.  oz.  j  ;  Tinctura?  Ser- 
pentariae,  fl.  drs.  vj ;  Aquae,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

In  low  fever  this  mixture  will  clean  the  tongue,  promote  the  action  of  the  skin  and 
kidnevs,  correct  the  oflensive  state  of  the  evacuations,  and  rouse  the  patient.  See  F. 
354. 

R.  Liquoris  Soda?  Chloratae,  fl.  drm.  j  ;  TincturaB  Cinchona3  Compositae,  fl.  drs.  vj  ; 
SpiritCis  Vini  Gallici,  fl.  drs.  xij  ;  Aquae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  every 
three  or  four  hours. 

In  low  fever,  with  great  prostration. 

369.  Sumbul  and  Mop. 

R.  Tincturae  Sumbulis,  fl.  drs.  vj  ;  Infusi  Lupuli,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

In  some  cases  of  hysteria,  epilepsy,  threatened  delirium  tremens,  &c.,  where  a 
stimulant  and  antispasmodic  is  needed.     See  F.  95. 


TONICS.  345 


370.   Quinine,  Rhubarb^  and  Hop. 

R.  Tinctune  QuiniiB  Compositae,  Tincturse  Khci,  Tincturaj  Liipuli,  aa  fl.  drs.  iv. 
Mix.     One  tcaspounfiil  in  a  wineglassfiil  of  water  twi(;e  a  day. 

In  dyspepsia  from  weakness  of  the  digestive  organs,  and  constipation.     See  F.  385. 


XVII.  TONICS. 

371.  Bark  and  Ammonia. 

R.  Ammonia}  Carbonatis,  gr.  30;  Tincturae  LavanduUe  Compositae,  fl.  oz.  j  ;  Infusi 
Cinchonaj  Flavie,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  every  six  hours. 

R.  Ammonia?  Carbonatis,  gr.  30:  Tincturse  Aconiti,  min.  xl ;  Tincturse  Cinchonie 
CompositaB,  fl.  drs.  vj  ;  Aquae  Menthse  Piperitae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part 
three  times  a  day. 

R.  Ammonia?  Carbonatis,  gr.  30;  Extracti  Opii  Liquidi,  min.  xxx ;  Spiritfts 
^theris,  fl.  drs.  iij  ;  Decocti  Cinchonse  Flava?,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  every  three  or  four  hours. 

In  cases  where  it  is  feared  that  a  deposition  of  fibrine  has  taken  place  in  the  heart 
or  one  of  the  large  vessels. 

R.  Spiritus  Ammoniie  Aromatici,  Spiritus  Chloroformi,  aa  fl.  drs.  vij ;  Liquoris 
Morphige  Hydrochloratis,  fl.  drs.  ij  ;  Extracti  Cinchonaa  Flavaj  Liquidi,  fl.  drs.  iv  ; 
Tinctura3  Cinchonaj  Flavse,  ad  fl.  oz.  iij.  Mix.  Direct, — "  One  teaspoonful  in  a 
wineglassful  of  Port  wine  three  times  a  day." 

In  certain  cases  of  phthisis  this  mixture  is  very  useful,  especially  in  conjunction 
with  cod-liver  oil  and  a  liberal  diet. 

372.  Ammonia,  Bark,  and  Rhubarb. 

R.  Spiritus  Ammonise  Aromatici,  fl.  drs.  iv  ;  Extracti  Cinchonas  Flavae  Liquidi, 
fl.  drs.  iss  ;  Tincture  Rhei,  fl.  drs.  iv  ;  Infusi  Rhei,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  twice  or  thrice  daily. 

In  nervous  depression,  &c.,  with  constipation, 

373.  Bark  and  Liquor  Potassce. 

R.   Liquoris  Potassa;,  fl.  drs.  iij  ;  Tincturas  Cinchonae  Composita?,  fl.  drs.  vj  ;  De- 
cocti Cinchonae  Flava?,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  twice  or  thrice  daily. 
In  debility  attended  with  the  lithic  acid  diathesis. 

374.  Bark  and  Serpentary. 

R.  Tincturae  Cinchonae  Compositae,  fl.  oz.  j  ;  Tincturae  Aconiti,  min.  xxx  ;  Tinc- 
turae  Serpentariae,  vel  Tincturae  Acteae  Eacemosae,  fl.  drs.  iij  ;  Aquaj  Menthas  Pipe- 
rita?, ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  some  cases  of  chronic  rheumatism,  lumbago,  and  rheumatoid  arthritis. 

375.  Bark  and  Hemlock. 

R.  Tinctura?  Cinchonae  Compositae,  fl.  drs.  vj  ;  Succi  Conii,  fl.  drs.  iv;  Aqua?  Pi- 
mentas,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 
In  chronic  diseases  attended  with  debility  and  pain. 

376.  Acid  3Iixtures  and  Bark. 

R.  Acidi  Sulphurici  Aromatici,  fl.  drs.  ij  ;  Syrupi  Aurantii,  fl.  oz.  j  ;  Tincturae 
Cinchonae  Compositte,  fl.  drs.  vj  ;  Infusi  Cinchonte  Flavte,  ad  fl.  oz.  viij.  3Iix.  One- 
sixth  part  twice  or  thrice  daily,  on  an  empty  stomach. 

Especially  useful  in  depressing  disorders  accompanied  with  occasional  attacks  of 
hemorrhaii-e. 


846  APPENDIX    OF   FORMULA. 

R.  Acidi  Phosphoric!  Diluti,  fl.  drs.  iss ;  Tincturne  Aconiti,  fl.  drm.  ss  ;  Tincturse 
Cinchoiiie  Compositse,  fl.  oz.  j  ;  Infusi  Aurantii,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

In  debility,  with  nervous  irritability. 

R.  Acidi  Nitrici  Diluti,  vel  Acidi  Phosphorici  Diluti,  fl.  drs.  iss  ;  Tincturie  Nucis 
Vomicffi,  fl.  drm.  j  ;  Extracti  Cinchonse  Plavse  Liquidi,  fl.  drs.  ij  ;  Aquffi  Menthse 
Piperita,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times  a  day,  two  hours  before 
each  meal. 

In  general  weakness,  with  nervous  exhaustion. 

377.  Acid  Mixtures  with  Calumbo,  S^e. 

R.  Tincturse  Calumbo,  fl.  drs.  vj  ;  Acidi  Sulphurici  Aromatici,  fl.  drs.  iss  ;  Syrupi 
Aurantii,  fl.  oz.  j  ;  Infusi  Aurantii,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times 
a  day,  when  the  stomach  is  empty. 

R.  Acidi  Hydrochlorici  Diluti,  fl.  drs.  iss ;  Acidi  Hydrocyanici  Diluti,  min.  xx ; 
Infusi  Chirataj,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times  a  day,  immediately 
before  the  meals. 

As  a  stomachic,  especially  in  the  dyspepsia  of  gouty  subjects. 

R.  Succi  Limonis  Kecentis,  fl.  drs.  xij  ;  Syrupi  Limonis,  fl.  oz.  j  ;  Infusi  Chiratse, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

Where  there  is  debility  with  a  threatening  of  rheumatic  fever.  In  cancer  of  the 
stomach,  &c. 

378.  Nitro-IIydrochloric  Acid  3Iixtures. 

R.  Acidi  Nitro-Hydrochlorici  Diluti,  fl.  drs.  iss — iij  ;  Tincturse  Chiratse,  fl.  drs. 
iij  ;  Tincturpe  Aconiti,  min.  xxx  ;  Syrupi  Aurantii,  fl.  oz.  j  ;  Infusi  Aurantii,  ad  fl. 
oz.  viij.     Mix.     One-sixth  part  three  times  a  day,  an  hour  before  each  meal. 

In  oxaluria,  dyspepsia,  rheumatoid  arthritis,  &c. 

R.  Acidi  Nitro-Hydrochlorici  Diluti,  fl.  drs.  ij ;  Acidi  Hydrocyanici  Diluti,  min. 
XXV  ;  Tincturse  Arnicae,  fl.  drm.  j  ;  Tincturaj  Gentianae  Composite,  fl.  oz.  j  ;  Infusi 
Sennse,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  twice  or  thrice  daily. 

In  d^'spepsia,  with  sluggish  action  of  the  liver.  The  eflScacy  of  this  mixture  may 
often  be  increased  by  giving  with  each  dose  a  pill  containing  one  or  two  grains  of 
sulphate  of  zinc  and  four  of  extract  of  gentian. 

R.  Acidi  Nitro-Hydrochlorici  Diluti,  fl.  drs.  ij  ;  Liquoris  Strychnife,  min.  xxx — 
fl.  drm.  j  ;  Spiritus  Chloroformi,  fl.  drs.  vj  ;  Tincturte  Zingiberis,  fl.  drs.  iij  ;  Aquae, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  any  form  of  functional  paralysis  after  all  the  appreciable  causes  are  remedied. 
Also  in  obstinate  debility,  hj-pochondriasis,  diabetes  insipidus,  alkaline  urine,  &c. 

R.  Acidi  Nitro-Hydrochlorici  Diluti,  fl.  drs.  iss;  Tincturse  Belladonnas,  fl.  drm.  j; 
Extracti  Pareirae  Liquidi,  fl.  drm.  j  ;  Decocti  Pareine,  ad  fl.  oz.  viij.  Mix.  One- 
sixth  part  every  six  hours. 

In  incontinence  of  urine,  when  the  reaction  of  the  latter  is  alkaline. 

379.   Quinine  Mixtures  and  Pills. 

R.  Quinise  Sulphatis,  gr.  12;  Acidi  Nitrici  Diluti,  re^  Acidi  Phosphorici  Diluti, 
vel  Acidi  Sulphurici  Aromatici,  fl.  drs.  iss ;  Tincturse  Lupuli,  fl.  drs.  vj  ;  Aqu»,  ad 
fl.  oz.  viij.     Mix.     One-sixth  ptirt  three  times  a  day. 

Amongst  other  purposes,  this  mixture  may  be  used  to  check  the  night-sweats  in 
phthisis. 

R.  Tincturse  Quinise  Compositse,  fl.  drs.  xiv ;  Tincturse  Aconiti,  fl.  drs.  ij  ;  Glyce- 
rini,  fl.  oz.  j.     Mix.     One  teaspoonful  in  a  wineglassful  of  water  three  times  a  day. 
In  neuralgia,  nervous  irritability,  weakness,  &c. 

R.  Quinio3  Sulphatis,  gr.  18;  Extracti  Lupuli,  gr.  40.  Make  a  ma.ss,  divide  into 
twelve  pills,  and  order  one  to  be  taken  three  times  a  day. 

R.  Quinife  Sulphatis,  gr.  4;  Acidi  Phosphorici  Diluti,  min.  xx  ;  Syrupi  Aurantii, 
fl.  drs.  iv;  Aquse.  ad  fl.  oz.  iv.     Mix.     One  small  tablespoonful  three  times  a  day. 
In  strumous  ophthalmia  and  other  cases  of  debility  in  children. 


TONICS.  347 

R.  Qiiinise  Rulphatis,  gr.  64;  Acidi  Siilphnrici  Dihiti,  min.  x;  Aqiite,  fl  drs.  iv. 
Mix.  Proin  lif'tcon  minims  to  half  a  drachm  (gr.  4-8)  may  be  carefully  injected  into 
the  subcutimoous  areolar  tissue. 

In  intermittent  fever,  &c. 

380.   Quinine  and  Steel. 

R.  Quinia3  Sulphatis,  Ferri  Snlphatis,  aa  gr.  12;  Liquoris  Strychnifc,  min.  xxx  ; 
Acidi  Suiphurici  Aromatici,  fl.  drs.  iss ;  Infusi  Quassias,  ad  fl.  oz.  viij.  Mix.  One- 
sixth  part  throe  times  a  day. 

Tile  black  stools,  which  are  passed  while  any  preparation  of  steel  is  being  taken, 
are  due  to  the  combination  of  the  metal  with  part  of  the  sulphur  of  the  food, — form- 
ing sulphuret  of  iron.    . 

R.  Quinise  Sulphatis,  gr.  9;  Acidi  Hydrochlorici  Diluti,  fl.  drm.  j;  Tincturae 
Arnicie,  min.  xxx — fl.  drm.  j  ;  Tincturae  Ferri  Perchloridi,  fl.  drs.  iss;  Infusi  Caryo- 
phylli,  ad  fl.  0/5.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  general  debility,  diphtheria,  erysipelas,  &c. 

R.  Quinife  Sulphatis,  gr.  12;  Tincturjc  Ferri  Perchloridi,  fl.  drs.  ij  ;  Tincturae 
Nucis  Vomicaj,  fl.  drm.  j  ;  Tincturas  Lupuli,  fl.  drs.  vj  ;  Magnesiae  Sulphatis,  oz.  1  ; 
Infusi  Lupuli,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  daily,  three  hours  after  break- 
fast. 

In  habitual  constipation  with  debility. 

R.  Quiniffi  Sulphatis,  Ferri  Sulphatis  Exsiccatffi,  aa  gr.  20;  Extracti  Hyoscyami, 
gr.  30.     Make  a  mass,  divide  into  twelve  pills,  and  order  one  to  be  taken  twice  a  day. 
In  debility  with  irritability  of  the  nervous  system. 

R.  Quiniae  Sulphatis,  gr.  12;  Ferri  Eedacti,  gr.  30;  Extracti  Aconiti,  gr.  12; 
Glycerini,  sufficient  to  form  a  mass.  Divide  into  twelve  pills,  and  order  one  to  be 
taken  an  hour  after  dinner  and  supper. 

In  neuralgia,  rheumatoid  arthritis,  painful  chronic  aflections  with  debility,  &c. 

R.  Ferri  et  Quiniae  Citratis,  gr.  30;  Tincturae  Chiratse,  fl.  drs.  iss;  Aquae,  ad  fl. 
oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

An  excellent  tonic  where  there  is  exhaustion,  with  a  weak  and  irritable  stomach. 
If  the  strong  bitter  is  objectionable,  Tincture  of  Calumbo  may  be  substituted  for  the 
Chiretta. 

381.  Quinine,  Steel,  and  Arsenic. 

R.  Tincturae  Quiniffi  Compositae,  fl.  oz.  j  ;  Liquoris  Arsenicalis,  min.  xviij  ;  Ferri 
et  Ammoniaj  Citratis,  gr.  30;  Aquae  Aurantii,  ad  fl.  oz.  viij.  Mix.  One-sixth  part 
three  times  a  day,  after  meals. 

In  diseases  of  the  skin,  &c.,  with  impoverished  blood. 

R.  Quiniae  Sulphatis,  gr.  9;  Acidi  Phosphorici  Diluti,  Tincturae  Ferri  Perchloridi, 
aa  fl.  drs.  iss;  Liquoris  Arsenici  Chloridi  (Phar.  Lond.  1851),  min.  xxx — fl.  drm.  j  ; 
Syrupi  Zingiberis,  fl.  drs.  vj  ;  Aquae,  vel  Infusi  Quassiae,  ad  fl.  oz.  viij.  Mix.  One- 
sixth  part  directly  after  breakfast,  dinner,  and  supper. 

In  many  skin  diseases,  rheumatoid  arthritis,  carbuncular  inflammation,  &c.  See 
F.  52,  899. 

382.  Quinine  and  Iodide  of  Iron. 

R.  Tincturae  Quiniae,  fl.  oz.  j  ;  Syrupi  Ferri  lodidi,  fl.  drs.  iij — \'j  ;  Infusi  Calumbae, 
ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  debility  with  a  strumous  taint,  chronic  rheumatism,  goitre,  &c. 

383.   Quinine  and  Belladotma. 

R.  Quiniae  Sulphatis,  gr.  24  ;  Extracti  Belladonnae,  gr.  4;  Camphorae,  gr.  30  ;  Con- 
fectionis  lloste  Gallicae,  sufficient  to  make  a  mass.  Divide  into  twelve  pills,  silver 
them,  and  order  one  to  be  taken  twice  or  thrice  daily. 

In  some  painful  diseases  (neuralgia,  cancer,  dysmenorrhoea,  &c.)  where  a  sedative 
and  tonic  are  needed.     See  F.  45. 


348  APPENDIX    OF    FORMULA. 

384.   Quinine  and  Ipecacuanha. 

R.  Quinife  Sulphatis,  gr.  12;  Pulveris  Ipecacuanhae,  gr.  12—24;  Extract!  Gen- 
tiaiiiB,  gr.  24.  Mix.  Divide  into  twelve  pills,  and  order  one  to  be  taken  every  day 
at  dinner. 

An  excellent  remedy  in  cases  of  slow  digestion.     See  F.  44. 

385.   Quinine  and  Rhuharh. 

R.  Quiniifi  Sulphatis,  gr.  24;  Pulveris  Pvhei,  gr.  36;  Glycerini  sufficient  to  form  a 
mass.     Divide  into  twelve  pills,  and  order  one  to  be  taken  night  and  morning. 

386.    Quinine  and  Ammonia. 

R.  Tincturaj  Quiniae  Compositpe,  fl.  oz.  j  ;  Glycerini,  fl.  drs.  vj  ;  Spiritus  Ammonife 
Aromatici,  Spiritfis  yEtheris,  aa  fl.  drs.  iij  ;  Extracti  Opii  Liquidi,  min.  xxx  ;  Infusi 
Aurantii,  vel  Infusi  Cinchonse  Elavaj,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  every  six 
hours. 

In  great  exhaustion,  with  low  muttering  delirium  and  restlessness. 

387.   Quinine  and  Nux  Vomica. 

R.   Quinia3  Sulphatis,  gr.   18;  Extracti  Nucis  Vomicae,   gr.   3 — 6;  Extracti  Gen- 
tian;e,  gr.  35.     Mix,  and  divide  into  twelve  pills.     One  to  be  taken  night  and  morning. 
In  debility  with  constipation.     See  E.  175,  409. 

388.  Substitutes  for  Quinine. 

R.  Beberiffi  Sulphatis,  gr.  30;  Acidi  Sulphurici  Aromatici,  min.  xl ;  Syrupi  Au- 
rantii, fl.  oz.  j  ;  Aquae  Aurantii,  ad  fl.  oz.  viij.    Mix.  One-sixth  part  three  times  a  day. 

In  neuralgic  afl'ections  assuming  a  periodic  character ;  as  well  as  in  intermittent 
and  remittent  fevers.  Beberia  does  not  produce  cerebral  disturbance  and  headache 
like  quinine.  This  sulphate  of  an  alkaloid  is  said  to  be  an  ingredient  of  Warburg's 
Fever  Drops. 

R.  Salicini,  gr.  60;  Extracti  Sarsas  Liquidi,  fl.  drs.  vj  ;  Infusi  Gentianse  Com- 
positi,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

During  convalescence  from  acute  disorders  of  the  digestive  organs.  The  antiperiodic 
properties  of  salicin  render  it  useful  in  intermittent  and  some  other  fevers. 

R.  Salicini,  gr.  120;  Glycerini,  fl.  oz.  j  ;  Tincturae  Aurantii,  ad  fl.  oz.  iij.  Mix. 
One  teaspoonful  in  a  wineglassful  of  water  night  and  morning. 

Where  the  stomach  is  easily  nauseated  and  cannot  digest  quinine,  this  formula  will 
be  useful. 

389.   Cod-Liver  Oil. 

The  oil  most  commonly  used  is  of  a  pale  straw  color,  the  dose  varying  from  a  tea- 
spoonful  to  a  large  tablespoonful  twice  or  thrice  daily.  It  should  be  taken  imme- 
diately after  meals ;  floating  it  on  milk,  coifee,  beef-tea,  orange  wine,  brandy  and 
water,  cherry  brandy,  &c.  Chewing  a  piece  of  lemon-peel  or  cinnamon,  or  a  few 
cloves  previously,  will  disguise  the  flavor.  Sometimes  it  is  preferred  made  into  an 
emulsion  ;  which  may  be  done  by  beating  it  up  with  an  equal  proportion  of  lime- 
water,  or  of  milk,  or  with  a  yolk  of  an  egg  and  some  compound  tincture  of  cardamoms. 
Dr.  De  .Fongh's  oil  is  pure,  and  is  prescribed  by  many  practitioners. 

Cod-liver  oil  may  be  impregnated  with  various  drugs, — such  as  any  of  the  essential 
oils,  morphia,  arscmic,  iodine,  mercury,  quinine,  zinc,  iron,  &c.  Too  large  a  quan- 
tity of  the  solution  must  not  be  made  at  a  time,  as  the  oil  soon  becomes  rancid.  Com- 
bined with  ozone  (an  allotropic  modiflcation  of  oxygen — hkxo^,  another,  and  t/jittoc, 
manner  of  existence),  it  has  been  found  to  lessen  considerably  the  froqflency  of  the 
pulse  in  phthisis.  The  dose  of  ozonized  oil,  according  to  Dr.  E.  Symes  Thompson,  is 
from  two  to  four  drachms,  two  or  three  times  a  day.     See  F.  22,  32,  283,  3'JO,  and  418. 


TONICS. 


349 


390.  Iodide  of  Iron  and  Cod-Liver  Oil. 

R.  Sjn-upi  Ferri  lodidi,  fl.  drs.  iv  ;  Miu-ilagini.s  Tragaoanthio,  fl.  oz.  j  ;  Olei  Mor- 
rhiue,  fl.  oz.  ivss.     Mix.     One  tablespoon fiil  twice  or  thrice  daily. 
In  some  forms  of  scrofula,  phthisis,  mild  constitutional  syphilis,  &c. 

R.  Potassii  lodidi,  gr.  3 — 5;  Glycerini,  fl.  drs.  ij  ;  Vini  Fcrri,  fl.  drs.  iv ;  Olei 
Morrhua),  fl.  drs.  vj.     Mix,  and  make  a  draught  to  bo  taken  twice  a  day. 
In  chronic  rheumatism,  tertiary  syphilis,  strumous  skin  disea,ses,  «!iisc. 

391.  Steel  and  Cocoa-nut  Oil. 

R.  Olei  Cocos  Nucis,  fl.  drs.  ij  ;  Spiritus  Ammonia;  Aromatici,  min.  xxx  ;  Ferri  et 
Amm()nia3  Citratis,  gr.  5;  Aqute  Menthie  Piperita?,  ad  fl.  oz.  j.  Mix,  and  make  a 
draught  to  be  taken  twice  or  thrice  daily. 

Deserving  of  trial  when  cod-liver  oil  causes  nausea. 

392.  Steel  and  Grlycerine. 

R.  Tinctura3  Ferri  Perchloridi,  fl.  drs.  iss — ij  ;  Zinci  Phosphatis,  gr.  6;  Tincturae 
Calumbie,  fl.  drs.  vj  ;  Glycerini,  fl.  oz.  j  ;  Aquae,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

In  some  cases  it  is  better  to  omit  the  glycerine  from  this  mixture;  administering 
cod-liver  oil  instead,  after  one  or  two  of  the  chief  meals  of  the  day. 

R.  Tincturte  Ferri  Perchloridi,  fl,  drs.  ij — iv  ;  Glycerini,  fl.  drs.  iv  ;  Aquae,  ad  fl. 
oz.  viij.     Mix.     One-eighth  part  every  three  or  four  hours. 

In  diphtheria,  erysipelas,  &c. 

R.  Spiritus  Ammoniae  Aromatici,  fl.  drs.  iv  ;  Ferri  et  Ammonise  Citratis,  gr.  40; 
Infusi  (^uassiae,  fl.  oz.  viss;  Glycerini,  fl.  oz.  j.  Mix.  One-sixth  part  three  times  a 
day. 

393.   G-riffitJis  Mixture  with  Aloes. 

R.  Misturae  Ferri  Compositae,  Decocti  Aloes  Compositi,  aa  fl.  oz.  iv  ;  Zinci  Sul- 
phatis,  gr.  12.     Mix.     One-sixth  part  twice  a  day. 

In  anaemia,  hypochondriasis,  general  debility  with  constipation,  &c. 

394.  Steel  and  Pepsine. 

R.  Ferri  Kedacti,  gr.  36 — 60;  Pepsinae  Porci,  gr.  36;  Zinci  Phosphatis,  gr.  18; 
Glycerini,  suflicient  to  make  a  mass.  Divide  into  twenty-four  pills,  silver  them,  and 
order  two  to  be  taken  every  day  at  dinner. 

In  anasmia,  &c.,  with  weakness  of  the  digestive  organs. 

R.  Ferri  et  Ammonias  Citratis,  gr.  20;  Spiritus  Vini  Gallici,  fl.  oz.  j  ;  Vini  Pep- 
sinae, fl  drs.  iv  ;  Aquas,  ad  fl.  oz.  vJ.  Mix.  One-half  to  be  taken  every  day  at  din- 
ner.    See  F.  420. 

395.  Steel  and  Hemlock. 

R.  Pilulaj  Ferri  Carbonatis,  gr.  60;  Extracti  Conii,  gr.  36 — 60.  Mix,  and  divide 
into  twenty-four  pills.     Two  to  be  taken  twice  or  thrice  daily. 

In  incipient  phthisis,  and  in  many  diseases  attended  with  cough  and  debility. 

396.  Steel  Electuaries. 

R.  Ferri  Peroxidi,  Mellis  Depurati,  aa  oz.  2.    Mix.     One  teaspoonful  twice  a  day. 
In  chorea,  &c,. 

R.  Ferri  Carbonatis  Saccharata?,  gr.  120 — 240;  Oxymellis,  fl.  oz.  iij.  Mix.  One 
teaspoonful  twice  or  thrice  daily  after  meals. 

397.  Steel  and  Hydrochloric  Acid. 

R.  Tincturae  Ferri  Perchloridi,  fl.  drs.  iss;  Acidi  Hydrochlorici  Diluti,  fl.  drs.  ij  ; 
Tincturae  Hyoscyami,  fl.  drs.  iij  ;  Infusi  Quassite,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 


350  APPENDIX   OF   FORMULA. 


398.  Steel  and  Gentian. 

'    R.   Felri  Sulphatis  Granulatse,  Extract!  Gentiante,  aa  gr.  30.     3Iix,  divide  into 
twelve  pills,  and  order  one  to  be  taken  three  times  a  day. 
In  chlorosis,  «&c. 

399.  Steel  and  Arsenic. 

R.  Vini  Terri,  fl.  oz.  iv;  Liquoris  Arsenicalis,  min.  xx  ;  Syrupi  Zingiberis,  fl.  oz. 
ij.  Mix.  One-sixth  part,  with  three  tablespooufuls  of  water,  three  times  a  day,  im- 
mediately after  meals. 

For  cases  of  purpura.  In  reduced  doses  as  a  tonic  and  alterative  in  some  of  the 
skin  diseases  of  children.     See  F.  52,  381,  402. 

R.  Syrupi  Ferri  Phosphatis,  fl.  oz.  ij  ;  Liquoris  Sodse  Arseniatis,  min.  xxx.    Mix. 
One  teaspoonful  in  a  wineglassful  of  water  directly  after  dinner  and  supper. 
In  some  forms  of  spleen  disease,  &c. 

400.  Steel  and  Cantharides. 

R.  Tincturse  Cantharidis,  fl.  drs.  iss ;  Glycerini,  fl.  oz.  j  ;  Misturas  Ferri  Com- 
posite, ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  debility  of  the  generative  organs,  some  forms  of  incontinence  of  urine,  &c. 

R.  Tincturse  Cantharidis,  Tincturse  Ferri  Perchloridi,  aa  fl.  drm.  j  :  Tinctura?  Cap- 
sici,  fl.  drs.  iss;  Syrupi  Hemidesmi,  fl.  oz.  j  ;  Aquae,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

401.  Steel  and  Ammonia. 

R.  Ferri  Tartarati,  gr.  60;  Spiritus  Ammonise  Aromatici,  fl.  drs.  iij  ;  Infusi  Quas- 
sias, ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  chlorosis,  leucorrhoea  from  relaxation  of  vaginal  mucous  membrane,  &c. 

R.  Ferri  et  Ammonias  Citratis,  gr.  40;  Ammonise  Carbonatis,  gr.  30;  Tincturae 
Zingiberis,  fl.  drs.  iij  ;  Aqua,  ad  fl.  oz.  viij.    Mix.    One-sixth  part  three  times  a  day. 

402.  Steel  and  Chlorate  of  Potash. 

R.  Tincturse  Ferri  Perchloridi,  fl.  drs.  iss;  Potassae  Chloratis,  gr.  120;  Liquoris 
Arsenicalis,  min.  xv  ;  Aquae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  or  four  times 
a  day,  in  a  wineglassful  of  water. 

In  certain  skin  diseases,  onychia,  &c.  Also  in  anaemia  dependent  on  a  syphilitic 
taint,  in  erysipelas  about  the  fauces,  and  in  tonsillitis,  &c.,  omitting  the  solution  of 
arsenic  from  the  mixture. 

403.  Steel  and  Citrate  of  Potash. 

R.  Ferri  et  Ammonias  Citratis,  gr.  60 ;  Spiritfis  Ammoniac  Aromatici,  fl.  drs.  iv; 
Potassae  Bicarbonatis,  gr.  120;  Infusi  Calumbte,  ad  fl.  oz.  viij.  Mix.  One-sixth  part 
to  be  taken  twice  a  day  with  one  tablespoonful  of  lemon-juice. 

As  a  tonic  where  there  is  nausea  and  dyspepsia. 

404.  Steel  and  Aloes. 

R.  Ferri  Carbonatis  SaccharatsB,  gr.  40;  Infusi  Anthemidis,  fl.  oz.  viij.  Mix. 
One-sixth  part  twice  a  day.  The  following  draught  is  also  to  be  taken  every  other 
morning  before  breakfast:  R.  Sodie  Phosphatis,  gr.  120;  Extracti  Ehei,  gr.  10; 
Decocti  Aloes  Compositi,  fl.  drs.  iv  ;  Aquaj  Carui,  fl.  oz.  j.     Mix. 

Useful  for  atonic  gouty  subjects. 

R.  Ferri  Kedacti,  gr.  30;  Pilulae  Aloes  et  Myrrhae,  gr.  24-40;  Extracti  Nucis 
Vomicae,  gr.  4.  Make  a  mass,  divide  into  twelve  pills,  and  order  one  to  be  taken 
three  times  a  day. 

In  anaemia  with  constipation.     See  F.  393. 


TONICS.  351 


405.  Phosphate  of  Iron. 

R.  Fern*  Phosphatis,  gr.  40;  Acidi  Phosphorici  Dihiti,  fl.  drs.  i.=s;  Syrupi  Au- 
rantii  Floris,  fl.  oz.  j  ;  Mucilaginis  Tragacanthai,  ad  fl.  oz.  viij.  Mix.  Ont'-.sixth 
part  three  times  a  day. 

In  scrofula,  cancer,  low  nervous  vigor,  &c. 

R.  Ferri  Phosphatis,  gr.  20;  Pulveris  Myrrhs,  gr.  15;    Sacchari  Albi,  gr.  30. 
Mix,  and  divide  into  six  powders.     One  to  be  taken  night  and  morning. 
In  rickets,  and  other  strumous  diseases  of  children. 

A  syrup  of  the  Phos])hates  of  Iron,  Lime,  Soda,  and  Potassa,  has  been  prepared  by 
Mr.  Parrish,  of  Phibulclpliia.  It  may  be  obtained  from  most  London  chemists;  be- 
ing known  as  "Chemical  Food."  The  dose  for  a  child  ten  years  of  age,  is  one  tea- 
spoonful  in  water  after  the  two  principal  meals  of  the  day. 

This  preparation  is  of  great  value  in  all  forms  of  strumous  disease,  and  general 
debility. 

406.  Steel  and  3Ianganese. 

R.  Ferri  Phosphatis,  gr.  120;  Manganesii  Phosphatis,  gr.  90;  Tincture  Calum- 
bse,  fl.  oz.  j  ;  Syrupi  Zingiberis,  fl.  oz.  ij.  Mix.  One  teaspoouful  in  u  wineglassful 
of  water  three  times  a  daj^ 

In  chlorosis,  scrofula,  &c. 

407.  Acetate  of  Strychnia. 

R.  StrychnifB  Acetatis,  gr.  1;  Acidi  Acetici,  min.  xx ;  Alcoholis,fl.  drs.  ij  ;  Aqufe 
Destillata?,  fl.  drs.  vj.  Mix.  Ten  drops  (=  to  gr.  1-50)  to  be  taken  in  water  thi-ee 
times  a  day. 

Kecommended  by  Dr.  Marshall  Hall  as  a  tonic  in  cases  of  nervous  exhaustion. 

R.  Strychnite,  gr.  1 ;  Pulveris  Zingiberis,  gr.  40;  Extracti  Gentianie,  gr.  60.  Mix 
very  thoroughly,  divide  into  twenty  pills,  and  order  one  to  be  taken  night  and  morn- 
ing. 

In  partial  paralysis,  amaurosis,  «&c.,  when  the  acute  symptoms  have  subsided. 

408.  Strychnia  and  Steel. 

R.  Ferri  et  Ammonite  Citratis,  gr.  40  ;  Liquoris  Strychnia,  fl.  drm  j.  (=  to  gr. 
^) ;   Infusi  Quassite,  ad  fl.  oz.  viij.     Mix.     One-eighth  part  twice  a  day. 
In  chronic  nervous  aftections  with  debility. 

R.  Ferri  Redacti,  gr.  40;  Zinci  Valerianatis,  gr.  20;  Strychnia^,  gr.  1;  Glycerini, 
suflicient  to  make  a  mass.  Divide  very  carefully  into  twenty  pills,  silver  them,  and 
direct  one  to  be  taken  three  times  a  day,  after  food. 

In  hypochondriasis,  great  nervous  depression,  &c. 

409.  Zinc  and  Nux  Vomica. 

R.  Zinci  Sulphatis,  gr.  24;  Extracti  Nucis  Vomicse,  gr.  6;  Extracti  Pihei,  gr.  30. 
Make  a  mass,  divide  into  twelve  ]iills,  and  order  one  to  be  taken  twice  a  day. 

In  weakness  of  the  muscular  system,  atony  of  intestinal  walls,  «S:c.     See  F.  175, 

387. 

410.    Valerianate  of  Zinc. 

R.  Zinci  Valerianatis,  gr.  12-24  ;  Extracti  Belladonnte,  gr.  3-6  ;  Extracti  Gen- 
tianie, gr.  24.  Make  a  mass,  divide  into  twelve  pills,  and  silver  them.  One  to  be 
taken  three  times  a  day. 

In  some  nervous  disorders,  in  cases  of  habitual  constipation,  and  in  spasmodic 
contraction  of  the  spliincter  ani. 

R.  Zinci  Valerianatis,  Zinci  Phosphatis,  ail  gr.  18  ;  Extracti  Pihei,  gr.  24.  Make 
a  mass,  divide  into  twelve  pills,  and  silver  them.  Order  one  to  be  taken  three  times 
a  day. 

For  epilepsy,  neuralgia,  hysteria,  &c.  The  valerianate  of  quinine,  of  soda,  of  am- 
monia, and  of  steel,  may  be  employed  in  the  same  manner.  In  some  cases  of  neu- 
ralgia as  many  as  twelve  or  twenty  grains  of  valerianate  of  ammonia  in  infusion  of 
calumbo  have  been  given  every  four  hours. 


352  APPENDIX    OF   FORMULiE. 


411.    Valerianate  of  Zinc  and  Quinine. 

R.  Zinci  Valerianatis,  gr.  12;  Quinite  Sulphatis,  gr.  6;  Pilulse  Ehei  Compositse, 
Extract!  Anthemidis,  aa  gr.  20.  Make  a  mass,  divide  into  twelve  pills,  and  silver 
them.     One  to  be  taken  three  times  a  day. 

In  hysteria,  neuralgia,  &c. 

412.    Valerianate  of  Steel  and  Savin. 

R.  Perri  Valerianatis,  gr.  24;  Olei  Sabinte,  min.  xxiv;  Pilulse  Assafoetidfe  Com- 
positse, gr.  30.  Make  a  mass,  divide  into  twelve  pills,  and  silver  them.  One  to  be 
taken  three  times  a  day. 

In  anjemia,  hysteria,  and  neuralgia  with  amenorrhoea. 

413.  Sulphate  of  Zinc. 

R.  Zinci  Sulphatis,  gr.  24  ;  Extracti  Aconiti,  gr.  12 ;  Extract!  Quassias,  gr.  24. 
Make  a  mass,  divide  into  twelve  pills,  and  order  one  to  be  taken  three  times  a  day. 

In  epilepsy  with  neuralgic  pains,  lumbago,  pleurodynia,  &c.  Its  efficacy  is  much 
increased  by  giving  cod-liver  oil  at  the  same  time. 

R.  Zinci  Sulphatis,  gr.  12-24;  Extracti  Conii,  gr.  36.  Make  a  mass,  divide  into 
twelve  pills,  and  order  one  to  be  taken  three  times  a  day. 

In  the  chronic  bronchitis  of  old  people,  as  a  tonic  and  sedative,  &c. 

414.  Phosphate  of  Zinc,  cfc. 

R.  Zinci  Phosphatis,  gr.  20-40;  Acidi  Phosphorici  Diluti,  fl.  drs.  iss  ;  Tincturae 
Cinchonae  Flavaj,  fi.  drs.  vj,  vel  Tincturae  Ferri  Perchloridi,  fl.  drs.  iss;  Aquae  Men- 
thae  PiperitiB,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

In  some  afli'ections  of  the  nervous  system  with  debility. 

415.   Oxide  of  Zinc. 

R.  Zinci  Oxidi,  gr.  24-40;  Extracti  Anthemidis,  gr.  30.  Make  a  mass,  divide 
into  twelve  pills,  and  order  one  to  be  taken  twice  a  day. 

In  chronic  alcoholism  (?),  chorea,  hysteria,  <tec.  Dr.  Golding  Bird  entertained  an 
opinion  that  zinc  hils  a  specific  influence  on  tlie  nervous  system,  just  as  iron  has  on 
the  blood.  The  dose  may  be  gradually  increased  until  twenty  or  even  thirty  grains 
of  the  zinc  are  taken  in  the  day.  It  can  sometimes  be  advantageously  combined 
with  opium. 

416.  Zinc,  Bark,  and  Crlycerine. 

R.  Zinci  Sulphatis,  gr.  12 — 20;  Tincturae  Cinchonae  Compositie,  fl.  oz.  j;  Gly- 
cerini,  fl.  drs.  xij ;  Aquae  Mentha;  Piperitae,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three 
times  a  day. 

During  convalescence  from  acute  disease,  especially  where  there  is  emaciation  with 
great  nervousness  and  constipation. 

417.  Phosphorus  Pills. 

R.  Micae  Panis,  gr.  60;  Aquas  Dostillatas,  sufficient  to  make  a  mass.  Then  add — 
Phosphori,  gr.  1.  Mix  thoroughly,  divide  into  twenty  pills,  and  order  one  to  be 
taken  thrice  daily. 

In  extreme  debility  and  mental  depression.     After  cholera,  diphtheria,  «&c. 

418.  Phosphorus  and  Oil. 

R.  Phosphori,  gr.  1  ;  01(>i  Morrhuae,  fl.  oz.  vj.     Mix.     One  or  two  teaspoonfuls 
three  times  a  day,  immediately  after  food. 
In  tuberculosis,  rickets,  .scrofula,  &c. 

R.  Phosphori,  gr.  1 ;  Olei  Amygdah-B,  fl.  oz.  iij.  Mix.  One  teaspoonful  in  a  wine- 
glassful  of  barley-water  three  times  a  day. 


TONICS.  353 

419.  Eypophosphile  of  Soda. 

oz^;iif'^M{^^P7;nriK.i?'  '1  ^fl^i%Hypopho.sphite,  gr.  30-80;  Infusi  Chirate,  fl. 
w,    \iij.     iviix.     Une-sixth  part  three  times  ii  day.  ' 

In  phthisis,  tabes  mesenterica,  <fee.     In  pr<.-ressive  locomotor  ataxy  the  efficaov  of 
wUhS'lur^''^  "'""^^'  by  giving  a  pill  containing  Nitrate  oVfcl;fv:f(F%9) 

bun.'  S!^^Ti!^-?°''''n-f'''l*'^'  ^'-  8f>-240;  Spiritiis  ^theris,  fl.  oz.  j  •  Tinotura>  Sum- 

^ni;it(.ySwL^r:';LSr;;;;y'-  ^^-  ^-  ^^^-  ^-  teasi;oon../in^£^e 

420.  Preparations  of  Pepsine, 

lescence  from  acute  disease  '"&'^'i"»  li^ness,  and  duiing  conva- 

coI!i:tSg'li^^;;;5ir;^i:;M'r^r^  '\'^^rr?  of  the  gastnc  juice;  a  secretion 
stance  havino-  the  n  }u?.  V  f  ^  ""  ""'^  hydrochloric  acids,  and  of  an  azoti^ed  sub- 
of  th    gi'trif  gl4       sSI-idLtor  ^  ■  ^''""  'rT  ""^^  ^'^"^  the  secretion 

pepsine  with  gTel  adv,nt  "  Th?s  ,tT  '  '''•"'''  T ^'  ^'^  '^"'^ '"  '^^  "«^  ^^  ^'■tifi'^i"! 
bags  (the  foiu?h  om  ,  J  th?  ^."^stance  is  usua  ly  prepared  from  several  rennet 
mucouVmen  bri.'  p      Tl     °*   *'^^^"'"'"'^"ts)  by  washing  them,  and  scraping  off  the 

to  the  liquor,  Zl^^^^^^^  A  sufficiency  of  acetate  of  lead  is  added 

passed  through    t'  ^T  it  is    ..  i      filt;'^    ^  '"'"'T".'  °'  ^^'phuretted  hydrogen 

in  such  pro,,ortior»  that  om-  mr?,  f      .  '        '  ' '°  ^T'""  '»  """"^  »"''  »t«ffll 

between  tw^iec^itreaj  SriL'^LC/o  ro7r;;::;;:^rs;,',  "Z  '"^  '°="'  ■=""" 

^    Morson's  ft;,,,,,,  ,„;„„  is  obtained  from  tile  .-astric  juice  oh,       if-  ..„.       u      t. 

p;:,;:fxXr  .'s  ,*edttr..™ : 

Riillnr.lr    w   p^  ^'^  'f^f^  oj  the  Same  chemist  are  convenient  and  atrreeable 

stoma  h  of the^'pT^'In^.^CLittfl'^"-""';  ''  '''  "'-"^  i-I^H-    from  the 
thor  superior  to^  hat  of  mo  t  othe    k^l  ^^^'^^^^^^^  ''""'^  ^'^*  ^""'"^  '^>'  ^'^^  «"- 

into  a  pill  with  glycerine.  ^'  '^'''^  ''  *'"'"  t^°  t«  ^^^  grains,  made 

And  lastly,  there  is  the  Rennet  or  Pepsine  wine  of  Dr  "Plli<:   ^f  n  i,r      .u 
tion  of  which  is  thus  described      T-ikp  f  hTct  !f     i     .•  ,^  ?    I^ublin,  the  prepara- 

a„deuto.ah„,,tthteeorSi„rif^th:'^p;",\°;:s!„v^^;e^;;;;:.:i:hS::S:n^ 


354  APPENDIX   OF   FORMULA. 

taining  few  glandular  follicles,  may  be  thrown  away.  Slit  up  the  organ  longitudinally  ; 
and  wipe  it  gently  with  a  dry  napkin,  taking  care  to  remove  as  little  of  the  clean 
mucus  as  possible.  Then  cut  it  into  small  pieces  (the  smaller  the  better),  and  put  all 
into  a  common  wine  bottle.  Fill  up  the  bottle  with  good  sound  sherry,  and  let  it 
remain  corked  for  a  fortnight ;  at  the  end  of  this  time  it  is  fit  for  use.  The  dose  is  a 
teaspoonful  in  a  wineglassful  of  water  immediately  after  meals.  Dr.  Ellis  also  sug- 
gests this  test  for  pepsine  :  Put  a  small  cup  containing  milk  in  a  vessel  of  hot  water 
until  the  milk  becomes  blood-warm.  Then  add  a  teaspoonful  of  rennet  wine ;  and  if 
it  be  genuine,  the  milk  in  two  or  three  minutes  will  become  as  solid  as  blancmange.— 
F.  394. 


XVIII.  UTERINE  THEEAPEUTICS. 

421.  Ferruginous  Emmenagogues. 

R.  Potassii  lodidi,  gr.  18 — 30  ;  Ferri  et  Ammonia?  Citratis,  gr.  40  ;  Tincturas  Nucis 
Vomicae,  fl.  drm.  j  ;  Infusi  Quassia?,  ad  fl.  oz.  viij.  Mix.  One-sixth  part  three  times 
a  day. 

In  amenorrhoea  with  a  torpid  circulation. 

R.  Syrupi  Ferri  lodidi,  Glj'cerini,  aa  fl.  oz.  j  ;  Olei  Limonis,  min.  x.  Mix.  One 
teaspoonful  in  a  wineglassful  of  water  three  times  a  day.     See  F.  32. 

R.  Pilulse  Ferri  Carbonatis,  gr.  30;  Pilulse  Cambogise  Compositae,  gr.  15;  Olei 
Sabinae,  min.  xij.  Make  a  mass,  divide  into  twelve  pills,  and  order  two  to  be  taken 
twice  a  day. 

In  amenorrhoea  with  anaemia  and  habitual  constipation. 

R.  Ferri  Valerianatis,  gr.  18  ;  Olei  Sabinae,  min.  xxiv  ;  Extracti  Aloes  Barbadensis, 
gr.  6  ;  Pilula?  Assafoetida  Composita?,  gr.  36.  Mix  thoroughly,  and  divide  into  twelve 
pills.     One  to  be  taken  three  times  a  day. 

In  amenorrhoea  with  hysteria.     See  F.  412. 

R.  Tincturae  Ferri  Perchloridi,  fl.  drs.  iss;  Potassae  Chloratis,  gr.  60;  Tincturae 
Acteie  Racemosa?,  fl.  drs.  iv ;  Infusi  Serpentarije,  ad  fl.  oz.  viij.  Mix.  One-sixth 
part  three  times  a  day. 

In  debility,  with  imperfect  menstruation,  pains  in  the  back,  and  an  irritable  con- 
dition of  the  buccal  or  gastric  mucous  membrane.     See  F.  320. 

422.  Stimulant  Emmenagogues. 

R.  Extracti  Ergotae  Liquidi,  fl.  drs.  iij  ;  Tincturae  Serpentariae,  fl.  drs.  vj  ;  Decocti 
Aloes  Compositi,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  early  every  morning. 
In  amenorrhoea  dependent  on  simple  atony  of  the  uterine  organs. 

R.  Potassii  Bromidi,  gr.  60;  Tincturae  Cantharidis,  fl.  drs.  iss;  Tincturae  Cinna- 
momi,  fl,.  drs.  vj  ;  Aquae,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

R.  Olei  Rutae,  min.  xv  ;  Extracti  Ergotae  Liquidi,  fl.  drs.  ij  ;  Mucilaginis  Traga- 
canthffi,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  three  times  a  day. 

R.  Boracis,  gr.  60;  Tincturae  Ergota?,  fl.  drs.  iv ;  Aquai  Cinnamomi,  ad  fl.  oz.  viij. 
Mix.     One-sixth  part  three  times  a  day. 

R.  Tinctura?  Hellebori  (Phar.  Lond.,  1851),  fl.  drs.  iij  ;  Syrupi  Zingiberis,  fl.  drs. 
vj  ;  Infusi  Senna?,  ad  fl.  oz.  viij.     Mix.     One-sixth  part  once  or  twice  a  day. 
In  amenorrhoea  with  torpid  action  of  the  bowels. 

R.  Liquoris  Strychniae,  fl.  drm.  j  ;  Tinctura?  Ferri  Perchloridi,  fl.  drs.  iss  ;  Tincturae 
Acetae  Racemosie,  fl.  drs.  iv ;  Ini'usi  Quassias,  ad  fl.  oz.  viij.  Mix.  One-sixth  part 
three  times  a  day. 

R.  Podophylli  Resinae,  gr.  6;  Extracti  Ilyoscyami,  gr.  24;  Pilulae  Aloes  et  Myr- 
rlue,  gr.  30.  Mix,  and  divide  into  t,welve  pills.  One  to  be  taken  at  bedtime  for  three 
or  four  nights  in  succession. 

Where  the  menstrual  flow  is  scanty,  and  the  liver  sluggish. 


UTERINE    THERAPEUTICS.  355 


423.  3Ieclicated  Vaginal  Pessaries. 

R.  Plunibi  lodidi,  gr.  80;  Extract!  Belladonn.'c,  gr.  24 — 40;  Butyri  Cacao,  oz.  1  ; 
Olei  Olivte,  fl.  drs.  ij.  Mix;  melt  into  a  mass  with  gentle  heat;  and  pour  it  into  a 
tube  or  roll  of  paj)cr,  about  eight  inches  long  and  of  the  circumference  of  the  little 
finger.  Divide  into  eight  pessaries,  and  order  one  to  be  introduced  into  the  vagina 
every  night  or  every  other  night. 

In  chronic  inflammation  and  induration  of  the  labia  uteri,  in  ovaritis,  in  pelvic 
cellulitis,  and  in  chroiiic  cystitis. 

For  an  account  of  the  advantages  of  cocoa  butter  over  other  materials  in  making 
these  pessaries  the  reader  is  referred  to  a  paper  by  the  author  in  the  "  Obstetrical 
Transactions,"  vol.  4,  p.  205,  London,  1863. 

R.  TJnguenti  Hydrargyri,  gr.  80 — 120;  Butyri  Cacao,  oz.  1 ;  Olei  Olivap,  fl.  drs.  ij. 
Mix.  Divide  into  eight  pessaries.  Where  there  is  tenderness  of  the  cervix  uteri,  or 
of  the  ovaries,  thirty  grains  of  Extract  of  Belladonna  or  eighty  grains  of  Extract  of 
Conium  should  be  added  to  the  mass. 

R.  lodoformi,  gr.  80;  Butyri  Cacao,  oz.  1 ;  Glycerini,  fl.  drs.  iss.     Mix.     Divide 
into  eight  pessaries. 
As  a  local  anaesthetic  in  cancerous  and  other  painful  uterine  diseases. 

R.  Extract!  Aloes  Socotrinae,  gr.  60;  Olei  Sabinae,  fl.  drm.  j ;  Butyri  Cacao,  oz.  1 ; 
Olei  Oliva?,  fl.  drs.  ij.  Mix.  Divide  into  eight  pessaries,  and  order  one  to  be  intro- 
duced into  the  vagina  every  night. 

As  an  emmenagogue  and  purgative. 

R.  Plumbi  Acetatis,  gr.  20;  Extract!  Opii,  gr.  24;  Butyri  Cacao,  oz.  1;  Glycerini, 
fl.  drs.  ij.     Mix.     Divide  into  eight  pessaries,  and  order  one  to  be  used  every  night. 
In  chronic  leucorrhcea,  acute  and  follicular  vaginitis,  &c. 

R.  Zinci  Oxidi,  gr.  60;  Extract!  Belladonnas,  gr.  40;  Butyri  Cacao,  oz.  1;  Olei 
Olivae,  fl.  drs.  ij.     Mix.     Divide  into  eight  pessaries. 

In  the  same  cases  as  the  preceding.  Also  in  cancer  of  the  cervix  uteri,  and  in  irri- 
tability of  the  bladder. 

R.   Potassi!  lodidi,  gr.  40;   Extract!  Conii,  gr.  120;   Butyri  Cacao,  oz.  1-;   Olei 
Olivae,  fl.  drs.  ij.     Mix.     Divide  into  eight  pessaries.     One  to  be  used  every  night. 
In  induration  of  the  labia  uteri  in  strumous  subjects. 

R.  Acidi  Tannic!,  gr.  120;  Pulveris  Catechu,  gr.  60;  Butyri  Cacao,  oz.  1;  Olei 
Olivae,  fl.  drs.  ij.  Mix.  Divide  into  eight  pessaries,  and  order  one  to  be  used  twice 
a  week. 

In  prolapsus  uteri  with  relaxation  of  the  vaginal  tissues,  and  in  menorrhagia. 

424.  Medicated  Uterine  Pessaries. 

R.  Acid!  Tannici,  Butyri  Cacao,  aa  oz.  ^.  Mix.  Divide  into  eight  pessaries,  each 
having  the  diameter  of  an  ordinary  stick  of  nitrate  of  silver. 

In  menorrhagia  with  a  patulous  condition  of  the  os  uteri,  one  of  these  pessaries  may 
be  introduced  up  the  canal  of  the  uterus  and  left  there.  It  soon  dissolves  and  coats 
the  lining  membrane  with  the  tannin. 

R.  Aluminis,  gr.  80;  Zinci  Sulphatis,  gr.  40;  Butyri  Cacao,  oz.  \.  Mix.  Divide 
into  eight  pessaries,  as  in  the  preceding  formula. 

R.  Unguent!  Hydrargyri,  Butyri  Cacao,  aa  gr.  200;  Extract!  Belladonna?,  gr.  20. 
Mix,  and  divide  into  eight  pessaries  as  in  the  first  of  these  formulae. 

425.  Vaginal  Injections. 

R.  Extracti  Haematoxyli,  oz.  1;  Aluminis,  gr.  120;  Aquae,  fl.  oz.  ij.  Mix,  and 
label — "  To  be  added  to  one  pint  of  cold  water  to  form  an  Injection." — It  is  to  be  used 
with  a  vulcanized  India  rubber  syphon  syringe,  a  pint  or  more  of  plain  water  being 
first  thrown  up. 

In  diseases  attended  with  an  ofl'ensive  discharge.  The  patient  should  be  cautioned 
that  the  fluid  will  dye  linen,  &c.,  soiled  with  it. 

R.  Zinci  Sulphatis,  oz.  1;  Aluminis  Exsiccatae,  oz.  5.     Mix.     Label, — "One  tea- 
spoonful  to  be  mixed  with  a  pint  of  tepid  or  cold  water  to  form  an  Injection." 
In  leucorrhcea,  gonorrhoea,  »S:c. 


356  APPENDIX    OF   FORMULA. 

R.  Zinci  Chloridi,  gr.  80;  Aquae,  fl.  oz.  iss.  Mix.  Label, — "One  teaspoonful  to 
be  mixed  with  a  pint  of  cold  water  to  form  an  Injection.  To  be  used  night  and 
morning." 

In  gonorrhoea. 

R.  Liquoris  Plumbi  Subacetatis,  fl.  oz.  vi  ;  Extracti  Papaveris,  oz.  2.  Mix,  and 
label, — "  One  large  tablespoonful  to  be  mixed  with  a  pint  of  warm  or  tepid  water  to 
form  an  Injection." 

In  cases  of  leucorrhcea,  with  an  irritable  condition  of  the  os  uteri  or  vagina ;  as 
well  as  in  rodent  ulcer  of  the  uterus. 

R.  Extracti  Papaveris,  oz.  1| ;  Tincturse  Belladonnse,  fl.  drs.  iv.  Mix,  and  label, — 
"  Two  teaspoonfuls  to  be  added  to  one  pint  of  linseed  tea,  to  form  an  Injection." 

As  a  soothing  remedj'  in  cancer  of  the  cervix  uteri,  when  there  is  but  little  ten- 
dency to  hemorrhage. — It  may  be  emploj^ed  twice  or  thrice  in  the  twentj^-four  hours. 

426.  Sponge-Tents^  ^c. 

For  the  purpose  of  dilating  the  mouth  and  cavity  of  the  uterus,  the  female  urethra, 
a  strictured  rectum,  or  a  contracted  orifice  of  the  male  prepuce,  nothing  can  be  better 
than  the  sponge-tents  introduced  into  obstetric  practice  by  Sir  James  Simpson. 
These  instruments  are  of  a  narrow  conical  form,  and  of  various  sizes.  They  are 
made  by  dipping  a  piece  of  sponge  into  water,  and  then  compressing  it  around  a  cen- 
tral wire  with  whip-cord.  After  drying,  the  cord  is  removed  ;  the  surface  of  the  tent 
being  then  coated  with  a  mixture  of  lard  and  wax,  while  three  or  four  inches  of  tape 
are  fastened  to  its  base.  The  tents  which  the  author  has  generally  used  have  been 
made  by  Duncan  &  Flockhart,  of  Edinburgh,  and  they  are  perfect.  A  metallic 
director,  somewhat  resembling  the  uterine  sound  with  a  sharp  point,  is  needed  for 
their  introduction  up  the  uterine  canal ;  while  their  removal  is  accomplished  by  pull- 
ing the  tape.  A  fresh  tent  must  be  introduced  every  twenty-four  or  forty-eight  hours, 
until  the  tissues  are  sufficiently  dilated  to  allow  the  finger  to  explore  the  cavity  of  the 
uterus. 

Dr.  Sloan,  of  Ayr,  has  suggested  the  use  of  the  dried  stem  of  the  sea-tangle 
(Laminaria  digitata)  as  a  substitute  for  sponge.  The  stem  of  this  common  marine 
plant  is  cylindrical,  soft,  flexible,  firm,  and  capable  of  being  greatly  reduced  in  size 
by  drying.  On  subsequently  being  supplied  with  suiBcient  moisture  it  dilates  to  at 
least  three  or  four  times  its  size.  The  tangle-tents  produce  equable  dilatation,  are  in 
all  respects  very  efficient,  are  cleanly,  and  ought  to  be  cheap.  They  are  more  easily 
introduced  into  the  uterus  than  the  sponge-tents,  but  they  are  also  more  liable  to  slip 
out  again  when  the  pressure  of  the  finger  is  removed.  In  employing  these  tents  it 
seems  best  to  dip  them  in  hot  water  just  prior  to  introducing  them  ;  avoiding  the  use 
of  oil,  iis  it  interferes  with  their  absorbing  power. 

Tents  may  also  be  made  of  gentian  and  of  elm  bark ;  but  the  author  has  had  no 
experience  with  these  kinds,  having  been  perfectly  satisfied  with  the  sponge  and  sea- 
tangle. 

427.   GalactopJiora  and  Cralactophyga. 

a..  Galactophora  {Ta\a,  milk  ;  (^£pa>,  to  bear),  or  Galactagogues  (rdXa ;  ayo>,  to 
drive  out),  are  remedies  which  increase  the  secretion  of  milk.  Defective  lactation  is 
not  common  amongst  healthy  mothers,  but  with  the  weak  and  delicate  it  is  very  fre- 
quent. When  it  arises  amongst  the  tirst  class  it  is  generally  due  to  over-feeding; 
when  amongst  the  second,  aniemia  is  its  cause.  In  either  class,  a  torpid  condition  of 
the  mammary  gland  may  be  its  source. 

Defective  lactation  from  plethora  will  be  best  treated  by  purgatives,  the  most  efficient 
being  castor  oil.  All  kinds  of  beer,  wine,  and  spirits  are  to  be  prohibited.  Animal 
food  is  to  be  allowed;  with  vegetables,  bread,  tea,  &c.  A  mixture  of  milk  and  soda 
water,  in  equal  parts,  forms  an  excellent  drink  in  these  cases.  The  patient  is  not  to 
be  weakened;  but  she  should  be  cautioned  against  the  vulgar  error,  that  a  large 
quantity  of  food  is  necessarj'  simply  because  she  is  nursing. 

Defective  lactation  frorn  aiicemia  is  not  uncommon.  When  the  weakness  is  not  such 
as  to  forlaid  suckling,  the  health  ought  to  be  improved  by  animal  food  ;  by  a  fair 
allowance  of  ale  or  porter;  and  by  taking  milk,  or  cocoa  made  with  milk,  instead  of 
tea  or  coflee.  A  raw  egg  beaten  up  in  a  tumblerful  of  milk,  once  or  twice  a  day,  will 
do  good.  Then  ammonia  and  bark  (F.  371)  may  be  given;  or  some  non-astringent 
ferruginous  tonic  (F.  403,  405) ;  or  cod-liver  oil. 

Defective  lac1atL<iufru7n  torpor  of  the  maynma  is  the  most  frequent  variety.  In  these 
cases  benefit  will  be  derived  from  irritating  the  gland  and  nipple, — as  by  the  careful 
use  of  the  breast  pump ;  by  drawing  out  the  nipple  several  times  with  the  fingers, 


UTERINE   THERAPEUTICS.  357 

before  the  infant  is  applied;  by  passinc;  an  electric  current  through  the  gland,  for 
fifteen  or  twenty  minutes  daily,  for  several  days  in  succession  ;  or  by  the  application 
of  a  hot  carrot  poultice,  during  some  hours  daily.  The  breasts  are  to  be  kept  warm. 
Moderate  sexual  intercourse  is  also  useful. — Beef  and  mutton,  game  and  poultr}-, 
■white  fish,  oysters,  stewed  eels,  potatoes,  parsnips,  lettuce,  carrots,  turnips,  ic,  will 
increase  the  secretion.  There  is  no  objection  to  stout,  or  to  any  other  kind  of  malt 
liquor,  provided  the  stomach  can  digest  it;  while  from  one  to  two  pints  of  cow's  milk 
should  be  allowed  daily. — With  regard  to  drugs  perhaps  the  most  efficacious  is  a  de- 
coction of  the  leaves  and  stalks  of  the  Ricimis  coynm.unift,  or  C'as/or-uil  plant.  Dr. 
Kouth  rccDinmiMids  the  administration  of  a  strong  decoction  of  this  plant  or  of  an 
extract;  the  dose  of  the  former  being  from  one  to  two  drachms  daily  in  water,  or  of 
the  latter  five  grains.  Tiie  castor-oil  leaves  nuiy  also  be  applied  over  the  breasts,  or 
an  infusion  of  them  may  be  used  with  lint  and  oiled  silk.  Amongst  other  remedies 
reputed  to  possess  galactagogue  properties  may  be  mentioned, — Aqixa  Ane^hi  or  Dill 
waier,  and  Oleum  Anethi;  Aqua  Anisi  or  Atiiseed  waler,  and  Oleum  Anisi ;  and  partic- 
ularly Aqua;  Famiculi  or  Fennel  water,  and  Olenm  Fveniculi.  The  dose  of  either  of  these 
waters  is  from  two  to  four  ounces,  and  of  the  oils  about  five  minims  on  a  lump  of 
sugar,  twice  or  thrice  daily. — The  value  of  such  agents  as  the  Malva  Sylvestris  or 
Ma7:sh  mallow,  of  the  Sc/xmaria  vaccnria  or  cow;  basil.,  of  the  juice  or  decoction  of 
Broom,-tops,  and  of  the  infusion  of  Althcea  root,  is  very  doubtful. 

Sure  ydpples  may  indirectly  be  the  cause  of  defective  lactation.  Slight  excoriations, 
as  well  as  chaps  and  fissures,  can  generally  be  healed  by  the  use  of  the  dilute  solution 
of  subacetate  of  lead,  or  by  the  liniment  of  lime,  or  by  an  ointment  of  balsam  of 
Peru,  or  by  a  lotion  containing  borax  and  glycerine.  Frequently  drying  the  nipple 
■with  a  soft  rag,  and  then  dusting  it  with  spermaceti  which  has  been  finely  powdered 
by  the  aid  of  a  few  drops  of  proof  spirit,  will  be  found  exceedingly  efficacious.  Where 
the  fissures  are  deep,  light  cauterization  with  nitrate  of  silver  often  answers  well ;  or 
the  painful  spots  may  be  painted  with  collodium,  leaving  the  summit  of  the  nipple 
free  for  the  escape  of  the  milk.  A  well-made  shield,  provided  with  an  artificial 
nipple,  will  often  enable  a  woman  to  suckle  who  would  otherwise  be  unable  to  do  so. 
The  child's  mouth  must  be  looked  to,  so  that  if  there  are  aphthae  they  may  be  cured. 

/?.  Galactophtg\  (ruAa,  milk  ;  0£tiy&),  to  shun)  are  the  remedies  employed  to  arrest 
the  secretion  of  milk. 

Extract  of  Belladonna,  is  I  believe  the  most  certain  agent  of  this  kind.  Reduced 
to  the  consistence  of  treacle,  by  the  addition  of  a  little  giyceriHe  or  water,  it  should 
be  freely  painted  over  each  breast,  night  and  morning  ;  the  parts  being  also  covered 
with  wet  lint  and  oiled  silk,  or  with  a  cold  bread  and  water  poultice.  At  the  same 
time,  one-quarter  or  one-third  of  a  grain  of  the  extract,  may  be  administered  twice 
or  thrice  daily,  if  a  speedy  eftect  be  desirable.  Sometimes  it  is  advantageously  given 
■with  quinine  and  camphor  (F.  383). 

Iodide  of  Potassium  often  succeeds,  and  is  particularlj'  useful  if  there  be  any  painful 
engorgement  of  the  glands.  Six  or  nine  grains  daily,  in  divided  doses,  should  be 
administered.  Occasionally  it  may  be  better  to  give  about  ten  minims  of  the  tincture 
of  belladonna  with  each  dose  ;  or  the  iodide  vany  be  combined  with  an  active  purga- 
tive salt,  as  the  sulphate  of  magnesia  (F.  31). 

Colchicum  has  not  succeeded  well  in  the  author's  hands  when  given  alone.  But 
combined  with  the  sulphate  of  magnesia,  in  the  proportion  of  twenty  minims  to  sixty 
grains,  administered  two  or  three  times  a  day,  it  has  appeared  serviceable. 

Camphor  has  been  recommended.  Three  or  four  grains,  with  the  same  quantity  of 
henbane,  may  be  given  in  a  couple  of  pills  at  bedtime  ;  while  frictions  with  the  cam- 
phor liniment,  or  the  compound  camphor  liniment,  may  be  employed  twice  or  thrice 
daily. 

Tobacco  acts  in  a  similar  manner  to  belladonna.  An  ointment,  made  bv  boiling 
half  an  ounce  of  fresh  tobacco  in  eight  ounces  of  lard,  is  to  be  kept  continually 
applied.     Or  this  remedy  may  be  enijdoyed  in  the  form  of  a  fomentation. 

Sage  tea  is  a  popular  remedy,  which  can  certainly  do  no  harm. 

428.  Aphrodisiacs  and  Anaphrodisiacs. 

et.  Aphrodisiacs  C A<ppo6i(na,  venery)  are  medicines  which  excite  or  increase  the 
sexual  [lowers. 

Many  remedies  have  been  supposed  to  act  as  sexual  stimulants,  but  the  majority  of 
those  which  have  been  recommended  merely  have  the  property  of  exciting  the  imagi- 
nation. This  is  especially  the  case  with  Musk,  Castoreum,  and  Ambergris;  extravagant 
suljstances  which  ladies  may  use  as  perfumes  if  they  please,  but  which  should  be 
abolished  from  the  Materia  Medica.  The  volatile  sulphurated  or  allyle  oils,  obtained 
from  alliaceous  and  cruciferous  plants  [Allium  sativum,  Allium  ceva,  Sinaj)is  nigra, 


358  APPENDIX    OF   FORMULA. 

Cochlearia  Armoracia,  <|"c.),  have  had  some  slight  repute.  Indian  hemp  and  Opium 
have  been  used  ;  but  the  latter,  at  least,  generally  exercises  a  contrary  eflect  to  that 
desired.  Ca)dharides,  Turpeniitie,  and  Borax  probably  possess  no  aphrodisiac  powers, 
though  popularly  thought  to  do  so.  The  only  remedies  which  may  truly  be  supposed 
to  act  as  sexual  stimulants  are  the  various  preparations  of  Iron,  Strychnia  and  Nux 
Votnica,  Quinine,  and  Phosphorus. 

ff.  Anaphrodisiacs  ('a,  priv.,  and  a<j>poiiina,  venery)  are  generally  believed  to  have 
the  power  of  repressing  the  sexual  feelings. 

Nauseants  {Tariarated  Antimonj/ and  Ipecacuanha),  drastic  purgatives  [Ela.ierium, 
Jalap,  Calomel,  ^c),  Camphor  in  large  doses.  Carbonate  of  Soda,  Hemlock,  Tobacco,  and 
Alcoholic  drinks,  probably  possess  anaphrodisiac  properties. 


XIX.  CLIMATES  FOR  INVALIDS. 

429.   General  Observations. 

Notwithstanding  the  excellent  writings  of  Sir  James  Clark,  Edwin  Lee,  Gran- 
ville, Burgess,  Alexander  Taylor,  D.  J.  T.  Francis,  Scoresby-Jackson,  and 
others,  many  invalids  migrate  every  autumn  to  the  south  of  Frajice,  Italy,  Spain, 
&c.,  merely  to  find  a  grave.  This  happens  partlj^  because  cases  of  far  advanced  dis- 
ease are  still  sent  abroad,  when  they  ought  to  be  kept  at  home  ;  partly,  because  a 
situation  unfavorable  to  the  particular  malady  is  selected,  the  laws  of  climate  being 
ill-understood;  and,  in  some  measure,  because  it  is  difficult  to  persuade  the  sick  that 
simple  change  to  another  country  is  only  one  of  the  means  by  which  they  are  to  re- 
gain health.  For  although  there  can  be  no  doubt  that  in  change  of  air  physicians 
have  an  efficient  remedial  agent,  yet  it  is  certain  that  this  remedy,  like  all  others,  is 
not  of  indiscriminate  application,  but  must  be  prescribed  with  judgment  and  dis- 
cretion. 

The  diseases  most  likely  to  be  cured  or  alleviated  by  the  benign  influence  of  change 
of  climate  are  the  following :  Pulmonary  consumption ;  chronic  laryngeal  and  bron- 
chial affections;  asthma;  disorders  of  the  digestive  organs,  with  the  various  forms 
of  dyspepsia;  chronic  gout  and  rheumatism;  functional  derangements  of  the  sexual 
organs;  affections  of  the  kidneys;  and  hypochondriasis.  A  change  is  beneficial  to 
strumous  delicate  children  ;  is  invaluable  as  a  restorative  during  convalescence  from 
acute  or  prolonged  disease;  and  especially  is  it  one  of  the  chief  resources  of  "pre- 
ventive medicine." 

There  is  no  model  climate :  no  country  can  boast  of  being  perfect.  All  that  the 
physician's  knowledge  and  tact  will  enable  him  to  do  is  to  select  that  situation  which 
possesses  the  greatest  advantages  and  the  fewest  drawbacks  for  the  particular  case  he 
has  in  hand.  Phthisis,  for  example,  is  prevalent  and  fatal  in  all  countries,  though 
more  so  in  some  than  others.  Moreover,  it  must  be  remembered,  that  through  the 
peculiar  nature  of  zymotic  (?w/i<5co,  to  ferment)  diseases,  towns  usually  healthy  are  apt 
to  be  periodically  visited  by  epidemics ;  and  such  places  can  only  be  avoided  by  con- 
sulting recent  returns,  or  by  instituting  inquiries  on  the  spot.  In  considering  the 
sanative  influence  of  any  climate,  attention  must  be  paid  to  the  aspect  of  the  locality, 
its  drainage,  and  its  elevation  above  the  sea  level ;  to  the  temperature  and  its  equa- 
bility; to  the  drj'ness  or  moisture  of  the  soil  and  atmosphere,  a  degree  of  heat  being 
often  well-borne  when  the  air  is  dry,  which  is  quite  unbearable  when  it  is  moist;  and 
to  the  nature  of  the  prevalent  winds.  The  amount  of  rain  which  descends  in  a  season 
is  not  of  such  moment  as  the  way  in  which  it  usually  falls;  a  region  liable  to  sharp 
heavy  showers  being  much  more  favorable  for  the  invalid,  than  one  where  it  drizzles — 
like  a  Scotch  mist — for  days  together.  Luxuriant  vegetation,  though  agreeable  to 
the  senses,  may  merely  mean  high  temperature  combined  with  moisture  ;  conditions 
not  favorable  to  the  phthisical.  So  also  the  districts  where  marshy  lands  abound,  or 
where  occasional  inundations  occur,  are  notoriously  unhealthy ;  for  the  evaporation 
of  the  water  lowers  the  temperature,  while  the  decaying  vegetable  matter  becomes 
the  source  of  malaria. 

The  beneficial  ettects  of  sea-air  are  due  to  its  purity,  to  the  equability  of  its  temper- 
ature, to  the  iodine  it  contains,  and  to  the  constant  presence  of  ozone.  The  latter 
— the  most  powerful  oxidizing  agent  known — is  a  stimuhint  to  all  the  vital  functions; 
but  if  in  excess,  it  causes  great  irritation,  particularly  of  the  organs  of  respiration. 


CLIMATES  FOR  INVALIDS.  359 

Ozone,  found  also  in  the  air  of  mountainous  and  rural  districts,  has  the  property  of 
deconi)iosinf>;  iodide  of  potassium,  uniting  with  the  potassium  and  liberating  th(!  iodine, 
which  latter  body  may  be  detected  by  starch.  Hence,  test-papers  saturated  with  a 
solution  of  iodide  of  jjotassium  and  starch  are  employed;  the  iodine,  when  freed  by 
the  ozone,  uniting  with  the  starch  and  forming  blue  iodide  of  starch.  (See  F.  389.) 
— While  sea-air  has  a  certain  amount  of  influence  in  preventing  tuberculosis,  it  is  by 
itself  insufficient  to  cure  this  disorder.  Mountain-air  is  also  pure,  has  an  average  low 
teuipcM-ature,  and  contains  a  large  proportion  of  ozone. 

Altliough  a  classification  of  climates  can  only  be  artificial,  and  merely  useful  as 
affording  a  rough  view  of  their  nature,  yet  those  countries  mostly  resorted  to  by 
invalids  may  be  arranged  in  four  divisions,  viz.,  the  relaxing,  sedative,  exciting,  and 
bracing. 

1.  In  the  relnxinrj  climates  (e.  g.,  Pisa,  Madeira,  Torquay)  there  is  an  elevated  tempe- 

rature with  an  excess  of  communicable  humidity.  Tliey  are  unfitted  for  cases 
where  we  wish  to  restore  diminished  tone — to  build  up  shattered  constitutions. 

2.  In  the  sedative  climates  (Rome,  Pau,   Cannes,  Venice)  we   find  a  freedom  from 

great  dryness  on  the  one  hand,  and  from  communicable  humidity  on  the  other. 
We  should  not  select  these  where  it  is  desirable  to  quicken  a  slow  circulation, 
or  where  the  secretions  are  too  abundant. 

3.  In  the  exciting  climates  (Nice,  Naples,  Montpellier,  Florence,  Genoa,  &c.)  there 

is  an  excess  of  dryness,  a  highly  electric  state  of  the  air,  an  excess  of  ozone,  and 
during  the  early  months  of  the  year  keen  irritating  winds.  Such  climates  are 
injurious  where  there  is  nervous  and  vascular  excitement,  a  tendency  to  inflam- 
mation, or  where  functional  repose  is  needed. 

4.  In   the  Smci«gf  climates  (Southport,   Brighton,  Mentone,  Malaga,  Algiers,  &c.) 

the  winter  temperature  while  comparatively  high  is  not  opjiressive,  the  air  con- 
tains a  moderate  proportion  of  ozone,  there  is  a  certain  amount  of  dryness,  and 
the  winds  are  less  irritating  than  in  the  exciting  class.  They  are  generally  to  be 
avoided  where  there  is  a  very  sensitive  state  of  the  system,  a  tendency  to  apo- 
plexy from  hypersemia,  and  in  many  affections  of  the  heart  or  large  vessels. 
But,  as  a  general  rule,  they  are  more  suited  to  cases  of  pulmonary  consumption, 
and  to  renal  and  hepatic  diseases  than  either  of  the  others. 

It  would  be  of  little  practical  use  to  introduce  an  extended  table  giving  an  approxi- 
mation to  the  death-rate  of  difterent  countries.  But  it  is  interesting  to  shortly  n'otice, 
that  on  an  average  of  ten  years  (1851 — GO),  the  annual  mortality  from  all  causes,  stands 
thus : 

For  England  and  Wales,      population  in  1801  being  20,066.224,  the  deaths  are  20  to  each  1000  persons  living. 

"     London, "  "  2,803.989,  "  24  " 

«    Bristol "  "  66,027,  "  27  " 

"  Birmingham,  ...  "  "  212,621,  «  27  "  " 

"  Manelif^ster,     ...  "  "  243,988,  "  31  "  " 

"  Liverpool,   ....  "  "  269,742,  "  33  "  " 

"     Dover "  "  31.575,  "  20  "  " 

"     Hastings «  «  26.631,  ''  18  "  " 

"  Eastbourne,     ...  "  "  10,721,  "  17  "  " 

"  Brighton,    ....  "  "  77,693,  "  22  "  " 

"     Worthing "  "  18,921,  "  18  "  " 

"  Isle  of  Wight,.    .    .  "  "  65.362,  "  17  "  " 

"  Scarborough,  ...  "  "  30,425,  "  21  "  " 

For  Paris,    ....  population  in  1862  numbering  1.606,141,  the  deaths  are  28  to  each  1000  persons  living. 
"     Berlin,.    ...  "  1861  "  547,.57i,  "  25  "  " 

"     Vienna,     ...  '•  1861  "  512,000,  "  49  "  " 

"     Turin "  1858  "  179,635,  "  26  "  " 

"     St.  Petersburg, .  '•  1858  "  620,131,  "  41  "  " 

"    Moscow,    ...  »  1858  "  386,370,  "  38  "  "     » 

When  the  locality  to  which  an  invalid  is  to  resort  has  been  decided  upon,  he  should, 
on  leaving  home,  be  provided  with  a  concise  code  of  laws  in  writing;  or  he  must  be 
directed  at  once  to  consult  a  physician  in  practice  at  the  town  selected.  His  route  had 
better  be  marked  out  for  him  ;  he  should  be  cautioned  as  to  the  rate  at  which  he  is  to 
travel ;  rules  must  be  laid  down  as  to  the  regimen  he  is  to  adopt ;  while  he  ought  to  be 
reminded  that  warm  clothing,  especially  flannel,  will  be  required.  Frccpicntly  it  will 
be  better  to  have  cheerful  apartments,  with  a  southern  aspect,  secured  beforehand  ;  so 
that  at  the  end  of  his  journey  a  few  days'  perfect  rest  may  be  enjoyed.  The  object  of 
the  tour  ought  to  be  clearly  explained,  while  he  is  to  be  warned  not  to  expect  too  much, 
especially  at  first.  The  physician  in  sending  his  patient  abroad,  is  merely  placing  him 
in  the  position  most  favorable  to  recovery, — but  still  where  other  remedies  and  general 
precautions  will  be  indispensable.  Foreign  travel  would  be  more  agreeable  to  most 
men,  could  the  plague  of  sight-seeing  be  dispensed  with.  But  for  the  sick  man  to  visit 
picture  galleries,  museums,  damp  old  ruins,  cold  churches,  &c.,  is  frequently  to  frustrate 


360  APPENDIX   OF   FOEMUL^. 

the  only  object  he  should  have  in  view,  viz.,  the  restoration  of  his  health.  In  giving 
directions  as  to  diet  it  must  be  recollected  that  travelling  is  very  exciting  and  wearying 
to  the  invalid ;  that  the  organs  of  digestion  almost  always  become  more  or  less  de- 
ranged;  and  that  many  articles  of  food  which  are  taken  with  advantage  in  England, 
disagree  in  warmer  latitudes. 

In  many  instances  the  author  has  found  it  advantageous  for  the  invalid  leaving 
England  for  several  months  to  carry  with  him  a  few  pure  drugs  ;  together  with  a  brief 
account  of  their  properties,  doses,  and  modes  of  combination.  Not  that  he  is  to  be 
encouraged  to  tamper  with  his  health  by  pla\'ing  the  dangerous  part  of  the  amateur 
phj'sician  ;  but  good  advice  cannot  always  be  procured,  or  it  may  perhaps  be  had  where 
only  inferior  drugs  are  obtainable  for  compounding  the  prescription.  The  medicines 
which  are  generally  ordered  are  these  : 

Sulphate  of  Quinia,  1  oz.  t  Aromatic  Powder  of  Chalk  and  Opium, 

Reduced  Iron,  1  oz.  3  oz. 


Liquid   Extract  of  Yellow  Cinchona,  4 

fl.  oz. 
Spirit  of  Ether,  6  fl.  oz. 
Chloroform,  2  fl.  oz. 
Bicarbonate  of  Soda,  4  oz. 
Compound  Powder  of  Rhubarb,  6  oz. 


Liquid  Extract  of  Opium,  2  fl.  oz. 
Sulphate   of  Zinc   (for  emetics,   lotions, 

coUyria,  &c.),  3  oz. 
Tincture  of  Arnica   (for  braises,  burns, 

&c.),  2fl.  oz. 
Morphia  and  Ipecacuan  Lozenges,  J  to 

1  lb. 


Scales  and  weights:  an  ounce  and  a  minim  measure:  a  small  spatula:  an  enema 
syringe,  the  cheaper  and  more  simple  the  better:  with  lint  and  strapping,  will  com- 
plete the  medical  equipment.  In  certain  special  cases  it  may  be  well  to  substitute  for 
some  of  the  above  drugs — blue  pill,  iodide  of  potassium,  colchictim,  gallic  acid,  pep- 
sine  prepared  from  the  pig's  stomach,  and  oil  of  peppermint.  Two  invaluable  medi- 
cines— brandy  and  cod-liver  oil — can  be  procured  everywhere. 

La  Poudre  Insecticide  is  sold  in  France,  and  is  a  very  efficacious  remedy  against 
fleas.  One  or  two  teaspoonfuls,  sprinkled  over  the  sheets,  serve  to  d'^stroy  these  foes 
to  comfort  and  sleep.  Persian  powder,  made  with  the  leaves  of  a  kind  of  groundsel, 
will  have  a  similar  eff"ect ;  and  so  will  campbor,  though  in  a  less  degree.  Mosquito 
curtains  may  also  be  taken  from  England  ;  ibr  mosquitos  are  a  serious  nuisance  to  all, 
but  especially  to  the  invalid,  and  they  continue  venomous  in  the  south  until  the  cold 
nights  set  in. 

430.  Middlesex. 

«t.  London. — This  city,  the  largest  and  most  healthy  in  the  world,  is  bounded  by 
moderate  hills  ;  has  a  soil  of  loam  and  gravel,  with  clay  resting  on  a  bed  of  chalk  ; 
and  is  some  fifty  miles  from  the  sea  to  the  south  and  east.  In  1801  the  area  of  Lon- 
don was  122  square  miles,— giving  about  23,000  persons  to  a  square  mile  of  surface. 
The  mean  annual  temperature  is  about  50°  F. :  the  average  winter  temperature  being 
38°,  ^nd  that  of  the  summer  63°.  The  nights  especially  are  warmer  than  in  the  en- 
virons. The  annual  rain-fall  is  21.6  inches;  the  average  number  of  days,  more  or 
less  wet,  being  178. 

Delicate  invalids  are  often  better  in  London  during  the  winter  and  spring,  than  in 
the  country,  owing  to  its  greater  warmth,  and  the  greater  steadiness  of  the  tempera- 
ture from  day  to  day. — Asthma  is  such  a  capricious  disease,  that  it  is  impossible  to 
say  beforehand  what  particular  climate  will  suit  any  special  example  of  it.  But  it  is 
certain  that  very  many  asthmatics  are  better  and  more  free  from  attacks  in  a  large 
city,  than  in  the  clearer  atmosphere  of  the  country.  Sufferers  from  this  atfection  can 
especially  ap})ly  to  themselves  the  words  of  Bacon, — "  The  goodness  of  the  air  is  better 
known  by  experience  than  by  signs." — Phthisical  invalids  will  find  BPwOMPTOn  or 
Chklsea  the  most  sheltered  spots  of  the  metropolis  ;  but  if  they  are  benefited  by  a 
bracing  air  they  must  resort  to  Bay.swater,  or  Highbury,  or  the  upper  part  of 
Kentish  T^wx,  or  to  Hiohgate. 

yg.  Hampstead. — Many  years  ago,  a  mineral  spring  of  repute  in  this  village  ren- 
dered it  a  fashionable  watering-place.  It  is  still  a  healthy  suburb.  From  the  heath, 
upwards  of  200  acres  in  extent,  there  are  many  tine  views.  The  air  is  pure  and 
bracing,  and  well-suited  for  children  and  convalescents.  The  low  parts  are  damp,  and 
%^hould  be  avoided. — Like  Greenwich,  Richmond,  Lewisham,  Sydenham,  «jcc.,  it 
often  aftbrds  a  convenient  temporary  residence  for  families  driven  from  their  town 
homes  by  the  outbreak  of  some  eruptive  fever  or  other  infectious  disease. 


CLIMATES    FOR    INVALIDS.  361 


431.  Kent. 

A.  Margate. — The  tonic  and  bracing  air  of  this  familiar  locality  render  it  a  very 
valuable  temporary  residence  for  many  invalids.  The  atmosphere  is  extremely  pure, 
the  soil  is  dry  and  absorbent,  and  the  water-supply  j^ood.  Perhaps  no  place  could 
be  named  which  is  more  suitable  for  restorinii;  tin;  iu-altb  of  children  and  young  people 
atHicted  with  any  form  of  scrofula.  The  bathing  is  good;  though  the  flatness  of  the 
sands  may  be  a  disadvantage  to  the  adult. 

The  mortality  among  the  r(!sidents  is  very  low.  For  a  long  series  of  years  (1888  to 
1862)  the  average  annual  death-rate  has  been  only  l(j  per  1000  for  this  class. — The 
season  lasts  from  May  until  the  end  of  September.  Being  open  to  the  north  and  east, 
the  air  is  very  bleak  during  the  late  winter  and  early  spring  months. 

8.  Kamsgate. — Is  much  frequented  in  the  summer  owing  to  its  gayety,  facilities 
for  sea-bathing,  &c.  It  is  an  excellent  residence  for  delicate  children  during  the 
months  of  October  and  November,  when  the  crowds  of  visitors  have  left.  The  climate 
is  warmer  than  that  of  Margate,  and  more  bracing  than  that  of  the  south-coast  water- 
ing-places.— Bkoadstairs  is  about  three  miles  from  liamsgate,  and  is  an  excellent 
and  quiet  sea-bathing  place  for  children. 

y.  Dover. — This  sheltered  town  is  generally  full  in  the  summer  and  autumn.  As 
a  winter  residence  it  is  colder  and  more  exposed  to  high  winds  than  Ha>tings,  but  it 
is  not  therefore  unsuitable  for  invalids  who  can  bear  a  bracing  air.  The  climate  proves 
especially  serviceable  to  those  subject  to  chronic  dyspepsia,  nervous  debility,  conges- 
tion of  the  liver,  &c. 

S.  Folkestone. — The  beautiful  country  in  the  neighborhood,  and  the  fine  tonic 
air  of  this  town,  render  it  a  most  agreeable  residence  from  the  end  of  May  until  the 
beginning  of  November.  Sufferers  from  dyspepsia,  nervous  irritability,  and  over- 
work will  derive  most  benefit  from  this  climate. — Sandgate,  about  two  miles  to  the 
east,  offers  a  milder  winter  climate,  with  an  exemption  from  fogs.  The  mean  winter 
temperature  is  41.7S°.  Consumptive  and  dyspeptic  invalids,  who  find  Brighton  too 
bracing,  and  Hastings  too  relaxing,  may  well  winter  at  Sandgate,  especially  if  they 
need  quiet  and  seclusion. 

432.  Smmx. 

ft.  Hastings  and  St.  Leonards. — Situated  about  midway  between  Brighton  and 
Dover,  the  climate  of  Hastings  is  very  useful  for  invalids  during  the  winter  months. 
Well  sheltered  from  cold  winds,  with  lofty  cliffs  and  undulating  downs,  a  beautiful 
and  cultivated  country,  a  dry  and  absorbent  soil  of  clay  overlaid  with  sand,  a  j)ure 
sea-air,  and  free  from  all  sources  of  malaria,  it  may  be  regarded  as  a  healthy  sedative 
climate  during  six  or  eight  months  of  the  year.  The  bathing  also  is  good  in  the  su?n- 
mer. — The  mean  annual  temperature  is  51°;  that  of  winter  being  40°,  of  spring  44°, 
of  summer  60°,  and  of  autumn  53°.  The  amount  of  rain  in  the  year  equals  about 
28.34  inches.  South  and  southwesterly  winds  are  most  prevalent  during  the  winter 
and  spring,  but  unless  high  they  cause  but  little  discomfort.  In  the  neighborhood 
are  various  springs  impregnated  with  iron  and  carbonic  acid,  but  they  are  not  much 
used. 

Hastings  is  suitable  for  cases  of  dyspepsia  with  loss  of  tone,  chronic  bronchitis, 
neuralgia,  chronic  rheumatism,  gout,  and  scrofula.  For  the  diseases  of  childhood  it 
is  a  good  locality.  The  author  has  not  seen  phthisical  sulyects  derive  much  benefit 
from  it,  however  ;  and  sometimes  he  has  thought  that  it  seemed  to  induce  luemoptysis. 
Dr.  Mackness  [HaMbigs  considered  as  a  Resort  for  Invalids,  London,  1842)  has  given 
a  table  of  the  causes  of  death  during  four  years  ;  from  which  it  appears  that  the  total 
number  was  865,  of  these  254  being  from  chest  affections,  and  of  these  latter  161  from 
consumption, — viz.,  91  inhabitants,  and  70  visitors. 

Although  Hastings  and  St.  Leonards  now  form  one  town,  yet  the  former  is  the 
warmest  and  most  protected,  and  hence  best  suited  for  very  delicate  invalids.  Such  as 
find  Brighton  agree  with  them  from  October  until  the  end  of  December,  may  often 
advantageously  spend  January  and  February  afSt.  Leonards. 

/?.  Eastbourne. — Filling,  as  it  were,  a  chasm  between  two  cliffs,  one  of  which  is 
Beachy  Head,  this  watering-place  is  rapidly  increasing  in  importance.  It  is  visited 
in  the  summer  for  sea-bathing ;  but  is  a  good  residence  for  invalids  requiring  a  bracing 
air  from  September  until  the  beginning  of  .January.  Cases  of  scrofula,  consumption, 
hydrocephalus,  and  tabes  mesenteriea  often  derive  benefit  here.  It  is  also  to  be  recom- 
mended in  functional  disorders  of  the  heart  and  nervous  system. 


362  APPENDIX    OF   FORMULA. 

y.  Brighton. — The  climate  is  bracing  and  restorative,  and  is  especially  beneficial  to 
invalids  during  the  autumn  and  early  months  of  winter.  Although  the  town  is  shel- 
tered on  the  north  and  northeast  by  the  Southdowns,  yet  from  the  beginning  of  Febru- 
ary until  nearly  the  end  of  May  cf)ld  north  and  easterly  winds  prevail,  which  prove  very 
irritating  even  to  the  healthy. "^  The  annual  fall  of  rain  is  25.6  inches.  The  western  is 
milder  but  more  damp  than  the  eastern  clitl';  but  the  tonic  air  of  the  latter  agrees  ad- 
mirably where  the  circulation  is  torpid.  The  Old  Steyne  offers  a  climate  intermediate 
between  that  of  the  western  and  eastern  cliffs. 

Diseases  of  a  nervous  hypochondriacal  type  are  much  relieved  by  the  invigorating 
atmosphere  of  Brighton.  Great  good  is  also  experienced  when  the  vital  powers  are 
sluggish,  when  there  is  anaemia,  or  when  disease  of  the  kidneys  exists.  Strumous 
children  and  convalescents  from  acute  disorders  may  also  be  sent  to  this  part  of  the 
coast.  It  is  unsuitable  for  individuals  of  an  irritable  or  plethoric  habit ;  for  such  as 
have  a  dry  harsh  skin ;  and  for  those  who  have  a  tendency  to  asthma,  inflammatory 
affections,  hemorrhoids,  &c. 

h.  Worthing. — Lying  twelve  miles  west  of  Brighton  and  with  an  aspect  almost 
due  south,  this  town  is  fully  exposed  to  the  sun's  rays.  It  is  sheltered  from  the  hot 
winds  of  summer  and  the  cold  of  winter  by  the  Southdown  hills,  which  have  an  average 
height  of  600  feet.  Hence  it  is  warm  in  winter  until  the  middle  of  February,  and 
cool  in  summer ;  the  air  being  neither  too  bracing  nor  too  sedative.  The  mean  tem- 
perature for  the  year  is  about  51°.  The  rainy  days  are  fewer,  and  the  quantity  of  rain 
that  falls  is  less,  than  at  Ventnor  or  in  the  West  of  England.  Occasionally,  the  east 
and  northeast  winds  render  the  air  very  bleak. — In  summer  the  fine  sands  afford 
excellent  bathing. 

Worthing  can  be  recommended  as  a  good  residence  for  convalescents ;  as  well  as  for 
sufferers  from  lung  diseases,  hooping-cough,  scrofula,  chronic  rheumatism,  and  renal 
affections. 

433.   Ha7npshire. 

a.  Southampton. — At  the  head  of  the  Southampton-water,  whicb  stretches  from 
the  Solent  and  Spithcad  into  the  interior  of  Hampshire  for  some  eleven  miles,  is  the 
clean  and  handsome  town  of  Southampton.  The  climate  is  said  to  be  mild  and  humid, 
intermediate  in  character  between  that  of  Devonshire  and  Hastings.  Though  shel- 
tered by  the  high  grounds  behind  it,  and  by  the  New  Forest,  yet  it  is  unsuited  for  most 
invalids,  the  temperature  being  variable.  The  effluvia  from  the  river  at  low  water  are 
often  very  unpleasant. 

A  short  distance  from  Southampton-water  is  Netley.  Here  has  been  built  the 
Royal  Victoria  Hospiial ;  which  is  especially  intended  for  the  reception  of  invalid 
soldiers  from  foreign  stations,  and  which  has  become  the  headquarters  of  the  Army 
Medical  School.  The  site  seems  to  have  been  well  chosen  ;  while  in  most  respects  the 
arrangements  of  the  building  are  excellent. 

/?.  Bournemouth. — This  favorite  watering-place,  situated  within  a  fine  bay,  is 
about  ten  miles  from  the  western  extremity  of  the  Isle  of  Wight.  It  is  well  screened 
by  hills  and  pine-woods  from  the  north  and  northeast  winds,  but  is  exposed  to  the 
southwesterly  gales.  Owing  to  the  nature  of  the  soil,  outdoor  exercise  is  practicable 
immediately  after  rain ;  while  there  are  great  facilities  for  easy  walking.  The  mean 
annual  temperature  is  51.00° ;  that  of  winter  being  42.38,  spring  49.11,  summer  60.18, 
and  autumn  51.71. 

It  may  be  recommended  as  a  quiet,  healthy  resort,  during  the  winter,  for  such  in- 
valids as  are  not  affected  by  moderate  variations  of  temperature,  for  those  who  are  weak 
without  having  actual  organic  disease,  and  for  persons  returning  from  tropical  countries. 
The  climate  is  mild  but  not  relaxing.  During  the  spring  and  early  summer  months 
thick  fogs  and  cold  easterly  winds  are  rather  prevalent.  In  summer  there  is  good  sea- 
bathing; but  the  heat,  and  clouds  of  fine  sand  which  rise  when  there  is  any  wind, 
render  Bournemouth  unpleasant  to  many  at  this  season. 

434.  Isle  of  Wight. 

a.  Ryde. — The  towns  on  the  north  side  of  the  island — Ryde  and  Cowes — are  more 
suitable  for  summer  visitors  requiring  change  of  air  and  occupation,  than  for  invalids 
needing  a  dry  atmosphere  and  repose.  Although  the  attractions  of  both  localities  are 
great,  yet  in  neither  is  the  bathing  good. 

/?.  The  Undercliff. — This  is  the  best  part  of  the  island  for  a  winter  and  spring 
residence.  It  extends  from  the  village  of  Bonchurch  to  Black  Gang  Chine,  a  distance 
of  six  miles  along  the  southeast  coast.  The  .scenery  is  romantic,  sea-fogs  are  rare  ex- 
cept towards  the  end  of  May  and  during  June,  and  both  soil  and  atmosphere  are  dry ; 


CLIMATES   FOR    INVALIDS.  363 

whilo  it  is  well  protected,  by  a  rancje  of  lofty  chalk  and  sandstone  hills,  from  the  north, 
northeast,  northwest,  and  west  winds.  It  is  raised  some  fifty  or  seventy  ft-et  above  the 
level  of  the  beach;  and  may  therefore  be  represented,  in  the  words  of  Sir  James 
Clark,  "as  a  lofty  terrace,  bucked  by  a  mountainous  wall  on  the  nortli,  and  o]>cn  on 
the  south  to  the  full  influence  of  the  sun  from  his  risinc;  to  his  t^oinp;  down,  duriiis^  that 
season  at  least  wiien  liis  iuHucnce  is  most  wanted  in  a  northern  (dimate." — The  mean 
annual  temperature  is  51.35°  ;  that  of  winter  being  41.89,  spring  49.00,  summer  00.08, 
and  autumn  53.58.  The  mean  annual  fall  of  rain  is  23.48  inches;  whereas  at  New- 
port, in  the  centre  of  the  island,  it  is  33.00. — The  best  season  is  from  the  beginning  of 
November  until  the  end  of  May:  between  August  and  October  it  is  too  relaxing  and 
humid. 

The  Undercliif  may  be  resorted  to  by  all  those  who  need  a  genial  and  agreeable 
winter  and  spring  climate.  It  allows  the  phthisical  invalid  to  re-oxygenate  his  frame 
by  almost  daily  exercise  in  the  open  air,  at  a  season  when  he  would  be  unable  to  do  so 
at  most  other  parts  of  England.  The  air  is  mild,  and  yet  of  a  bracing  tonic  character  ; 
and  hence  it  difl'ers  from  that  of  Torqumj,  which  is  of  a  more  moist  and  relaxing  na- 
ture. Patients  with  laryngeal  and  bronchial  affections,  hepatic  and  renal  disease, 
atonic  and  nervous  dyspepsia,  and  children  with  glandular  swellings  or  strumous  ulcers, 
do  verj'  well  at  this  part  of  the  island. 

435.  Dorsetshire. 

a.  Poole. — Standing  on  a  peninsula,  this  old-fashioned  town  is  an  agreeable  place 
for  such  as  have  to  be  driven  from  books  and  business  to  quiet  and  idleness.  Owing  to 
geographical  peculiarities  in  its  position,  the  tides  in  Poole  harbor  ebb  and  flow  twice 
in  the  twelve  hours. 

0.  Wetmotjth. — This  town,  with  the  adjacent  Melcombe-Reois,  is  a  favorite 
summer  resort;  the  beautiful  bay  of  the  latter,  with  its  fine  sands,  being  well  adapted 
for  bathing.  In  the  autumn  and  winter,  the  temperature  is  equable;  whilst  the  air 
is  so  pure  that  it  is  suitable  for  invalids  froin  various  diseases.  Indeed,  so  healthy 
is  the  climate,  that  Dr.  Arbuthnot  is  reported  to  have  jocosely  said,  "A  physician 
could  neither  live  nor  die  at  Weymouth."  As  it  is  the  nearest  English  port  to  Guern- 
sey, seventy  miles  distant,  it  forms  the  station  of  the  mail  boats. 

436.  Devonshire. 

a.  BuDLEiGH  Salterton. — A  quiet  retired  village,  nearly  five  miles  to  the  east  of 
Exmouth,  in  a  small  open  valley  on  the  sea-shore.  Eor  invalids  who  can  climb  the 
neighboring  hills  it  offers  a  mild  and  protected  winter  residence. 

p.  Dawlish. — Resorted  to  in  summer  for  bathing.  Dawlish  may  be  recommended 
as  a  winter  resort  for  those  needing  a  mild  air.  It  is  more  humid  than  Torquay. 
Protected  from  northerly  and  southwesterly  gales,  it  is  still  unfavorable  in  the  spring, 
owing  to  the  biting  east  wind  which  finds  access  to  the , picturesque  valley  on  either 
side  of  which  this  small  town  is  placed. 

y.  Exmouth. — The  new  portion  of  this  town  stands  high,  and  is  much  exposed  to 
Avind  from  every  quarter.  The  old  part  lies  along  the  margin  of  the  river  and  the 
base  of  Beacon  Hill,  and  is  damp  ;  though  it  has  the  advantage  of  being  protected 
from  southwesterly  and  northerly  gales.  Invalids  who  require  a  bracing  air  may  be 
benefited  here ;  but  the  cold  variable  weather  in  winter  makes  it  unsuitable  for  those 
with  pulmonary  complaints. 

i.  Salcombe. — Well  sheltered,  this  is  said  to  be  the  warmest  spot  on  the  southwest 
coast.  For  such  as  need  a  mild  and  equable  winter  temperature  this  small  spot  would 
be  useful  were  it  not  for  the  want  of  convenient  ground  for  exercise. 

£.  SiDMOUTH. — Recommended  in  summer  and  autumn  for  its  bathing.  Sidmouth 
is  also  a  good  situation  for  invalids  requiring  a  mild  relaxing  air  during  winter.  The 
mean  annual  temperature  is  50.1°  ;  that  of  winter  being  40.3,  of  spring  48.1,  of  sum- 
mer 00.3,  and  of  autumn  51.0. — The  annual  rain-fall  is  122.08  inches,  the  average  num- 
ber of  days  on  which  rain  falls  in  the  year  being  141. — It  is  tolerably  protected  from 
the  northwest  and  north. 

?.  Teignmouth. — The  mean  winter  temperature  is  six  degrees  higher  than  that  of 
London,  while  that  of  summer  is  five  degrees  lower.  On  account  of  its  exposed  posi- 
tion it  is  not  suitable  as  a  winter  home  for  the  sick. 

r)-  ToRQTJAT. — The  climate  of  this  favorite  locality,  while  mild  and  equable,  is  less 
humid  than  that  of  many  other  places  on  the  southwest  coast.     It  has  a  southern  as- 


364  APPENDIX   OF    FORMULA. 

pcct,  and  is  sheltered  on  all  other  sides  by  heights.  Mean  annual  temperature  •52.1'^; 
the  average  for  the  winter  being  44.0,  spring  50.0,  summer  61.2,  and  for  the  autumn 
53.1.  The  annual  amount  of  rain  is  28.20  inches;  and  it  falls  on  about  132  days  in 
the  year.  The  season  is  from  September  to  May  ;  and  though  it  is  not  absolutely 
necessary  for  the  invalid  to  leave  during  summer,  yet  it  will  be  better  for  him  to  do 
so.     November  is  generally  very  tine,  being  bright  and  sunny. 

Torquay  is  useful  in  many  oases  of  phthisis,  chronic  bronchitis,  laryngeal  affections, 
and  rheumatism.  In  heart  disease,  when  this  organ  is  oppressed  without  much  lower- 
ing of  the  vital  powers ;  in  inflammatory  dyspejisiu,  with  an  over-irritable  condition 
of  the  mucous  membranes  generally  ;  and  for  invalids  returning  from  tropical  cli- 
mates,— this  town  may  be  recommended. 

The  climate  has  a  soothing  influence  upon  the  organs  of  respiration  ;  but  the  effect 
upon  the  nervous,  digestive,  and  muscular  systems  varies  according  to  the  situation 
which  the  invalid  adopts  for  his  residence.  -Dr.  Radclytfe  Hall  recommends  a  feverish 
excitable  consumptive  patient  to  lodge  in  a  sheltered  part  close  to  the  sea,  provided 
sea-air  does  not  disagree.  When  the  feverishness  is  less  marked,  and  there  is  danger 
from  a  sinking  of  tlie  powers  of  life,  a  situation  part- way  up  the  hills  suits  better  ;  or 
the  beautiful  district  of  Meadfoot,  protected  from  the  east  and  northeast  by  an  ex- 
tensive range  of  cliff,  may  be  selected  if  close  proximity  to  the  sea  be  desirable.  After 
a  residence  at  the  sea-level  for  a  time,  removal  to  the  houses  on  the  southern  faces  of 
the  hills  often  proves  useful. 

e.  Exeter. — This  fine  old  cit}',  though  standing  upon  elevated  ground,  is  sheltered. 
Except  during  July  and  August  (when  it  is  close  and  relaxing),  it  offers  an  advan- 
tageous residence  for  invalids  requiring  a  residence  away  from  the  sea.  Its  mean 
temperature  in  winter  is  41.4°,  spring  49.5,  summer  62.0,  and  autumn  51.9.  The 
average  number  of  days  on  which  rain  falls  in  the  year  is  162,  the  annual  amount 
being  31.90  inches. 

Other  neighboring  inland  towns  are  agreeable  and  healthy, — Kingsbridge,  Totnes, 
Newton-Abbott,  Tiverton,  Crediton,  Cullompton,  Uttery,  Honiton,  &c.  Of 
the  moor  towns,  it  need  only  be  said  the  air  is  moist  and  misty.  Dartmoor  is  bleak 
and  chilly,  the  mornings  and  evenings  even  of  summer  being  cold. 

437.   Cornwall. 

a.  Penzance. — This  seaport,  on  the  northwest  side  of  Mount's  Bay,  is  about  ten 
miles  from  the  Land's  End.  The  climate  is  mild  but  relaxing.  It  has  a  mean  annual 
temperature  of  51.8°  ;  the  mean  for  the  winter  being  44.0,  for  the  spring  49.6,  for  the 
summer  60.2,  and  for  the  autunm  53.3.  As  a  winter  residence  for  invalids  it  possesses 
the  twofold  advantage  of  warmth,  and  great  steadiness  of  temperature  during  the  day 
and  nigiit.  The  disadvantages  are  that  it  is  much  exposed  to  wind  and  storm,  and 
that  it  is  humid — the  annual  rain-fall  being  44.6  inches.  It  should  be  avoided  in  the 
spring. 

Penzance  may  be  useful  in  chronic  bronchitis,  in  the  earliest  stage  of  consumption 
if  there  is  a  dry  harsh  cough  with  scanty  expectoration,  and  in  the  case  of  aged  in- 
valids who  derive  benefit  from  a  warm  moist  atmosphere.  It  is  injurious  in  phthisis 
with  relaxation  of  the  mucous  membranes  and  co})ious  secretion,  in  cases  of  hemor- 
rhage, in  atonic  dyspepsia,  and  in  debility  of  a  low  nervous  type. 

0.  Land's  End. — The  climate  somewhat  resembles  that  of  South  Devon,  but  as 
regards  humidity  and  exposure  to  winds  it  is  inferior.  Invalids  should  not  remain 
in  this  district  during  the  winter  and  sj)ring. 

438.   Gloucestershire  and  Worcestershire. 

A.  Bristol. — This  city,  situated  chiefly  in  Gloucestershire  but  partly  in  Somer- 
setshire, has  nothing  to  recommend  it  to  an  invalid.  A  few  years  since,  a  gentleman 
who  assured  the  author  that  he  always  suffered  either  from  gout  or  asthma,  remarked 
that  in  Bristol  he  was  generally  afflicted  with  the  former,  but  never  with  the  latter; 
though  dirccth'  he  left  this  spot  his  breathing  became  impeded.  Of  the  two  evils  he 
preferred  a  smoky  city  with  gout,  to  pure  country  air  and  asthma. 

0.  Clifton. — Built  on  the  sides  and  summit  of  a  precipitous  limestone,  hill,  about 
one  mile  west  of  Bristol.  In  former  days  invalids  resorted  to  this  spot  on  account  of 
its  hot  well :  now  it  is  in  repute  for  its  mild  winter  climate.  The  mean  temperature 
for  the  year  is  51.26°;  that  for  the  winter  being  39.91,  spring  49.79,  summer  63.87, 
and  autumn  51.49.  The  annual  rain-fall  is  32.56  inches  ;  and  the  number  of  rainy 
days  about  169.  The  lower  part  of  the  town  is  much  milder,  and  more  humid  than 
the  upper ;  and  hence  while  preferable  during  winter  for  many  cases,  is  too  relaxing 


CLIMATES    FOR    INVALIDS.  365 

in  tlio  summer.  The  loftier  situations  (such  as  York  Crescent,  with  its  soutliern 
aspect  and  sheltered  sunny  promenade),  are  beautifully  situated  and  well  adapted  for 
invalids  durinj^  the  summer  and  autumn  months. 

QIk^  Hot  Well  lies  at  the  foot  of  St.  Vincent's  Rock.  It  yields  an  abundant  sup- 
ply of  water  at  ahout  75''  F.,  containing  small  nuantities  of  magnesia  and  lime,  with 
an  unusual  amount  of  carbonic  acid  gas.  Owing  to  the  latter,  it  might  |i(Thaps  be 
advantageously  taken  in  dyspepsia  with  irritability  of  the  gastric  mucous  membrane  ; 
but  it  is  very  rarely,  if  ever,  employed  medicinally. 

y.  Malvern. — Perhaps  there  are  few  more  healthy  and  pleasant  spots  in  the  king- 
dom for  a  summer  residence  than  this.  Built  on  the  declivity  of  the  ^Malvern  Hills, 
situated  eight  miles  8.8.  W.  of  Worcester,  the  scenery  is  all  that  can  delight  the  con- 
valescent, or  the  man  who  has  broken  d(jwn  from  over-work.  The  air  is  pure  and 
invigorating;  and  is  well  adapted  for  bracing  the  system  of  such  invalids  as  can 
bear  an  elevated  site.  Owing  to  the  eastern  aspect  of  the  village,  the  strong  winds 
of  the  winter  and  spring  are  severely  felt. 

There  are  two  springs  in  the  neighborhood,  which  may  be  frequented  for  amuse- 
ment. But  the  waters  of  St.  Anne's  Well  and  of  the  Holy  Well  are  only  pure  and 
soft;  the  very  small  quantities  of  muriate  of  lime,  sul})hate  of  soda,  and  carbonate 
of  lime  which  they  contain,  being  useless  in  a  medical  point  of  view. 

439.  Lancasliire  and  Yorkshire. 

a..  SouTHPORT. — On  the  west  coast  of  Lancashire,  between  the  mouths  of  the  Mer- 
sey and  the  Kibble,  this  watering-place  is  eighteen  miles  from  Liverpool  and  thirty- 
two  from  Manchester.  The  climate  is  bracing  and  sedative,  the  air  dry  but  not  irri- 
tating, fogs  are  very  rare,  and  the  atmosphere  is  light  and  pure.  The  temperature 
is  variable,  changes  occur  ra]>idly,  while  the  mean  for  the  j'ear  is  54°.  The  sea-bath- 
ing is  good,  the  shore  sandy,  the  water  clear  and  pure,  and  the  bay  so  well  shel- 
tered tliat  it  is  seldom  too  rough. 

As  a  summer  and  autumnal  residence  it  is  useful  in  laryngeal,  bronchial  and  pul- 
monary atlections  ;  in  tuberculosis;  in  dyspepsia  with  constipation  and  flatulence;  in 
chronic  rheumatism ;  in  some  forms  of  paralysis  ;  and  in  nervous  depression  after 
long  illness. 

iS.  Scarborough. — Built  on  the  slopes  of  a  beautiful  bay  on  the  Yorkshire  coast, 
this  town  is  resorted  to  in  summer  for  its  sea-bathing.  The  season  extends  from 
June  to  October.  It  is  suitable  for  nervous  and  hypochondriacal  patients,  for  such 
as  have  been  over-worked  and  need  change  of  scene  and  amusement,  and  for  conva- 
lescents requiring  a  bracing  air. 

A  short  distance  from  the  town  are  two  niineral  wells, — the  North  or  cJiah/heate, 
and  the  South  or  saline  spring.  There  is  not  much  ditference,  however,  between  their 
waters;  those  of  both  being  aperient,  alterative,  and  slightly  tonic.  Their  tempera- 
ture is  about  49'' ;  and  they  yield  nitrogen  gas,  carbonate  of  iron,  chloride  of  sodium, 
sulphate  of  magnesia  (most  abundant  in  the  South  spring),  sulphate  of  lime,  and  bi- 
carbonate of  lime.  They  may  perhaps  be  useful  in  habitual  constipation,  torpidity 
of  the  liver,  and  scrofulous  complaints. 

■y.  Filey  has  most  of  the  advantages  of  Scarborough,  with  the  additional  one  for 
the  invalid  of  quiet  and  retirement.     It  has  also  a  saline  chalybeate  spring. 

/.  AVhitby. — The  air  of  this  sea-port  town  is  bracing  and  pure,  the  sands  are  ex- 
tensive and  atlbrd  good  bathing,  while  there  is  a  chalybeate  spring  which  is  thought 
wi'll  of  for  its  mild  tonic  properties.  As  at  Filey,  the  season  extends  from  the  be- 
ginning of  June  until  the  end  of  September. 


440.  Ireland. 


a..  Kingstown. — This  is  one  of  the  best  frequented  sea-bathing  places  in  Ireland. 
Situated  about  seven  miles  southeast  of  Dublin,  on  the  southern  shore  of  the  bay, 
the  harbor  is  said  to  be  one  of  the  most  splendid  artiticial  ports  in  the  United  King- 
dom. 

The  sharp  and  bracing  air  of  Kingstown  proves  injurious,  during  the  latter  part 
of  the  winter  and  the  early  spring  months,  to  patients  with  disease  of  the  lungs. 


366  APPENDIX    OF   FORMULA. 

jg.  HOLYWOOD. — A  small  watering-place  much  used  by  the  residents  of  Belfast, 
from  which  city  it  is  about  live  miles  distant.  The  beach  is  sandy,  and  good  for 
bathing. 

y.  QuEENSTOWN  (Covc). — A  town  which  consists  of  a  series  of  terraces,  built  on 
the  southern  acclivity  of  Cove  island,  in  Cork  harbor.  It  is  well  sheltered  from 
northerly  winds  ;  is  exposed  to  the  full  influence  of  the  sun  ;  and  the  winter  climate 
is  admirable,  being  mild  and  equable.  The  mean  temperature  for  the  year  is  51.9"; 
that  for  the  winter  being  44.1,  spring  50.1,  summer  61.3,  and  autumn  52.0.  The  an- 
nual rain-fall  is  33.25  inches ;  the  average  number  of  days  on  which  there  is  wet  be- 
ing 131.  The  invalid  should  settle  here  about  the  end  of  October;  and  he  will 
scarcely  have  a  day  during  the  ensuing  four  or  live  months  when  he  will  be  unable 
to  take  exercise  in  the  open  air.  Owing  to  the  way  in  which  the  houses  are  built  at 
a  variety  of  elevations,  the  exact  locality  chosen  must  depend  upon  the  patient's 
malady  and  strength. 

All  diseases  needing  a  sedative  and  slightly  humid  atmosphere  may  derive  benefit 
at  Queenstown.  Laryngeal,  bronchial,  and  pulmonary  complaints  are  especially  re- 
lieved by  a  winter  residence  here;  and  so  also  are  dyspeptics,  strumous,  rheumatic, 
and  cutaneous  aflections.  It  is  admirably  suited  for  delicate  children  ;  and  for  con- 
valescents from  hooping-cough,  eruptive  fevers,  &c.  Functional  disorders  of  the 
uterine  system  are  often  cured  by  it.-^In  the  summer  there  is  excellent  sea-bathing. 


441.  Scotland. 


The  climate  of  Scotland  is  remarkably  equable  throughout  the  year  ;  the  summer 
heat  and  winter  cold  being  mitigated  by  the  ocean  winds.  The  mean  temperature 
for  the  year  is  about  47*^ ;  that  for  the  northern  counties  being  higher  than  for  the 
eastern.  The  prevailing  winds  are  from  a  westerly  quarter  ;  blowing,  for  more  than 
two-thirds  of  the  year  from  between  the  southwest  and  northwest  points.  In 
spring  and  early  summer  cold  east  winds  prevail.  The  atmosphere  is  moist,  nearly 
100  inches  of  rain  falling  annually  in  some  of  the  mountainous  parts  ;  though  along 
the  southern  shores  of  the  Firth  of  Forth  the  amount  is  under  30,  at  Glasgow  about 
29,  and  at  Musselburgh  not  more  than  24  inches. 

The  air  of  Edinburgh,  though  neither  genial  nor  mild,  is  yet  salubrious  ;  and  is 
said  to  be  favorable  to  longevity,  as  well  as  to  the  development  of  the  mental  and 
physical  powers.  The  city  extends  northwards  to  the  shores  of  the  Firth  of  Forth  ; 
Granton  and  the  old  fishing  village  of  Newhaven  being  only  separated  from  the  town 
by  a  pleasant  walk.  The  elevated  situation  of  the  city  renders  it  exposed  to  violent 
winds ;  but  the  eflect  of  these  is  favorable,  at  all  events  to  the  inhabitants  of  the 
Old  Town,  by  driving  away  many  impurities.  As  a  place  of  education,  for  youths 
needing  a  bracing  climate,  it  has  great  advantages. 

The  old  city  of  St.  Andreavs,  situated  on  a  rocky  promontory  some  fifty  feet 
above  the  level  of  the  sea,  has  a  wholesome  genial  climate.  It  should  be  avoided  in 
the  spring  months,  as  it  is  then  visited  by  a  disagreeable  chilly  mist  from  the  north- 
east; but  from  July  until  the  end  of  October  the  air  is  pleasant  and  salubrious.  Suf- 
ferers from  rheumatism,  or  invalids  with  weak  lungs  had  better  not  remain  long  in 
this  city. 

On  the  western  coast  there  are  several  localities  which  seem  to  possess  good  winter 
clinuites  for  invalids.  The  island  of  Bute,  in  the  Firth  of  Clyde,  has  many  advan- 
tages;  the  air  being  mild  and  equable,  though  rather  humid.  Its  mean  temperature 
for  the  year  is  48.25°  ;  that  for  winter  being  39.02,  spring  46.66,  summer  58.06,  and 
autumn  48.59.  The  annual  rain-fall  is  38.62  inches  ;  there  being  more  or  less  wet  on 
about  150  days.  Snow  rarely  falls  in  the  winter,  and  there  is  a  freedom  from  fogs. 
It  is  protected  from  the  east  winds  of  spring ;  and  there  are  great  opportunities  for 
outdoor  exercise.  The  climate  being  rather  sedative,  invalids  needing  a  strong 
bracing  air  must  seek  it  elsewhere. 

Hypochondriacs,  sufferers  from  habitual  constipation  or  sluggish  action  of  the 
liver,  and  young  men  with  a  predisposition  to  phthisis,  are  often  much  benefited  by 
a  summer  or  autumnal  walk  through  the  Hiohlanu.s;  and  certainly  for  the  over- 
worked literary  or  j)rofessional  laborer  nothing  can  be  more  invigorating  than  such 
a  tour.  "I  verily  believe  that  1  should  die,"  said  Sir  Walter  Scott,  "if  I  did  not 
see  the  heather  every  year." 


CLIMATES   FOR   INVALIDS.  367 


442.    The  Channel  Islands. 

All  the  Channel  Islands  are  remarkable  for  their  beautiful  and  varied  scenery,  for 
the  temptations  the}'  otter  to  the  zoologist  and  botanist,  the  mildness  and  humidity 
of  their  climates,  the  absence  of  great  heat  in  summer  and  great  cold  in  winter,  and 
for  the  equability  and  duration  of  autumn.  The  violent  east,  northeast,  and  north 
winds  which  prevail  in  the  spring,  are  exceeding!}'  disagreeable  and  injurious. 

The  climate  of  the  Channel  Islands  is  generally  favorable  to  chronic  disease,  to 
asthma,  atiections  of  the  urinary  organs,  and  to  convalescents  from  acute  inflamma- 
tions of  the  organs  of  respiration.  The  old  and  the  young  also  are  beneiitcd  by  it. 
It  is  unfavora;ble  in  chronic  rheumatism,  hepatic  disorders,  structural  diseases  of  the 
uterus  or  ovaries,  nervous  dyspepsia,  hypochondriasis,  and  in  cases  where  tliere  is  a 
tendency  to  hemorrhage.  Pulmonary  consumption  appears  to  be  as  common  and 
fatal  among  the  inhabitants  as  in  most  other  localities. — The  most  favorable  time  for 
a  stay  in  either  of  the  group  is  from  August  until  the  beginning  of  February.  In 
some  instances,  a  change,  for  a  time,  from  one  island  to  another,  is  productive  of 
good. 

These  islands  may  be  reached  by  steamers  from  Southampton  or  Weymouth  in  less 
than  twelve  hours.  Invalids,  especially  ladies  and  children,  sliould  choose  their  day 
of  sailing  so  as  to  avoid  a  rough  passage  across  the  English  Channel;  and  so  that 
they  may  not  have  to  land  in  small  boats.  The  packets  can  generally  enter  the  har- 
bor of  St.  Peter's  Port  in  Guernsey,  and  that  of  St.  Helier's  in  Jersey,  exce])t  near 
low  water  on  a  receding  tide. 

Guernsey,  the  most  westerly  and  exposed  of  the  islands,  has  an  average  annual 
temperature  of  51.50";  that  for  winter  being  44.2,  spring  47.7,  summer  59.9,  and 
autumn  53.8.  Sea  fogs  are  rare.  The  mean  annual  rain-fall  is  rather  less  than  35 
inches,  falling  on  164  days,  and  more  often  in  night  than  day.  The  walks  are  too 
hilly  for  most  invalids. 

Jersey  is  the  largest  of  the  group  of  islands,  and  the  most  important ;  being  about 
twelve  miles  long,  with  an  average  breadth  of  live  miles.  The  surface  of  hill  and 
dale  is  well  wooded  ;  the  coast  is  rocky  and  precipitous  ;  and  it  is  exposed  to  the  wind 
from  every  quarter.  The  mean  yearly  temperature  is  the  same  as  for  Guernsey ; 
during  three-quarters  of  the  year  the  average  being  higher,  while  it  is  lower  in  the 
winter.  Nevertheless,  the  latter  is  mild,  frost  and  snow  being  very  rare.  The  daily 
range  of  the  thermometer  is  small,  but  it  is  greater  than  in  Guernsey.  St.  Helier's 
contains  nearly  half  the  population  of  the  island  ;  but  it  is  more  foggy  and  humid, 
and  therefore  less  suited  for  invalids,  than  St.  Aubin's,  which  lies  three  miles  to  the 
southwest  of  it.     The  sands  are  good  for  summer  bathing. 

The  air  of  Alderkey  and  Sark  is  usually  said  to  be  drier  and  more  bracing  than 
that  of  Guernsey ;  while  that  of  the  latter  is  less  relaxing  than  that  of  Jersey. 


443.  Soiith  of  France. 

tt.  Patj. — This,  the  chief  tovr'n  of  the  department  of  the  Basses-Pyrenees,  is  about 
125  miles  south  of  Bordeaux  and  56  miles  east  of  Bayonne.  It  may  be  reached  from 
London  in  48  hours  ;  and  the  season  lasts  from  the  beginning  of  November  until  the 
end  of  May.  The  mean  annual  temperature  is  about  56'^.  The  average  for  Septem- 
ber, October,  and  November  is  56.4;  that  for  December,  January,  and  February 
42.8;  while  for  March,  April,  and  May  it  is  54.0.  The  annual  rain-fall  is  about  43 
inches,  the  rainy  days  numbering  119.  Owing  to  the  gravelly  soil  any  quantity  of 
moisture  is  readily  absorbed.  Dr.  Playfair,  quoted  by  Sir  James  Clark,  sums  up  the 
nature  of  the  climate,  thus:  "Calmness,  moderate  cold,  bright  sunshine  of  consid- 
erable power,  a  dry  state  of  atmosphere  and  of  the  soil,  and  rains  of  short  duration. 
Against  these  must  be  placed, — changeableness,  the  fine  weather  being  as  short-lived 
as  the  bad,  rapid  variations  of  temperature,  within  moderate  limits.  In  autumn  and 
spring  there  are  heavy  rains."  The  air  in  December,  January,  and  February  is  dry, 
and  out  of  the  sun,  cold  ;  but  even  in  these  months  the  rays  of  the  latter  are  so  pow- 
erful that  the  pedestrian  ought  to  protect  his  hc^ad  with  an  umbrella.  There  are  very 
few  days  on  which  the  invalid  will  be  unable  to  take  exercise  between  12  and  3 
o'clock. 

Pau  is  not  influenced  by  the  west-northwest  wind,  the  Cijxius  of  the  ancients ;  nor 


368  APPENDIX   OF   FOKMUL^. 

by  the  north  wind  or  Bise  which  produces  a  biting  cold  ;  nor  by  the  northwest  wind 
or  Minii-al:  in  fact  the  climate  is  calm  and  soothing,  high  winds  being  rare.  It  is 
useful  in  cases  with  a  scrofulous  taint,  in  preventing  generation  of  tubercle,  and  in 
checking  softening  of  tubercle  when  formed.  Indeed,  as  Dr.  Taylor  states,  the  pre- 
disposition to  disease  favorably  influenced  by  this  town,  may  be  summed  up  in  one 
general  principle, — viz.,  wherever  it  depends  upon  increased  nervous  and  arterial 
action,  permanently  produced,  either  by  temperament  or  by  some  cause  leading  to 
more  active  disease. 

The  climate  is  sedative,  modifying  nervous  and  vascular  irritation;  and  therefore 
beneficial  in  irritations  of  the  mucous  membrane  of  air-passages  or  alimentary  canal. 
It  is  unsuitable  where  the  powers  of  life  are  declining  ;  in  chronic  catarrh  or  bron- 
chitis of  old  people,  with  loss  of  tone  and  excessive  expectoration  ;  in  chronic  rheu- 
matism or  gout,  with  debility  of  digestive  organs ;  in  tendency  to  apo]>lexy  from 
passive  congestion;  in  chlorosis  ;  and  in  disorders  attended  with  congestion  of  venous 
system  and  diminished  nervous  energy.  In  all  these  cases  the  climate  of  Nice  is  the 
remedy.  In  short,  Pau  is  to  be  chosen  when  there  is  "functional  derangement  of  a 
tonic  irritable  type,  which  paves  the  way  to  organic  mischief."  Acting  on  persons^ 
in  health  the  air  lowers  the  tone  ;  makes  the  sanguine,  phlegmatic  ;  and  the  choleric, 
melancholic. 

0.  Biarritz. — A  fashionable  sea-bathing  village  on  the  shores  of  the  Bay  of  Bis- 
cay, some  5  miles  southwest  of  Bayonne,  and  65  miles  from  Pau.  The  roads  between 
the  two  places  are  excellent,  and  communication  by  diligence  or  omnibus  very  ea.sy. 
It  can  be  reached  from  London  in  about  48  hours.  Tiie  air  is  warm  ;  the  tempera- 
ture of  the  sea  high;  and  there  is  always  a  soft  invigorating  sea-breeze.  When 
benefit  has  been  derived  from  a  winter  at  Pau,  it  is  often  advisable  for  the  patient  to 
go  to  Biarritz  for  the  summer ;  returning  to  Pau  for  a  second  winter.  The  sandy 
gently-shelving  beach  is  well  adapted  for  bathing,  which  is  no  slight  luxury  in  water 
at  a  temperature  of  75°  F. 

According  to  Dr.  Henry  Bennet,  the  climate  not  only  renders  Biarritz  a  favorite 
summer  and  autumn  watering-place,  but  puts  it  among  the  eligible  winter  stations 
of  the  south.  It  is  cheaper  also  in  winter  than  summer,  being  then  almost  deserted 
by  fashionable  visitors.  In  cases  of  severe  disease  it  is  not  equal  to  Pau,  Ajaccio,  or 
Mentone,  the  winter  breezes  from  the  Bay  of  Biscay  being  often  very  violent. 

y.  MoNTPELLiER. — The  reputation  which  this  city  formerly  enjoyed  as  a  winter 
residence  for  consumptive  patients  has  entirely  gone.  The  climate  is  dry,  irritating, 
and  changeable;  and  though  the  heat  of  the  sun  is  great,  yet  the  winter  winds  are 
cold  and  unbearable.  Mean  temperature  of  the  year  59.5°;  winter  44.2",  and  sum- 
mer 76°.  Phthisis  is  very  prevalent  amongst  the  native  population.  Invalids  with 
relaxed  mucous  membranes  and  copious  secretions,  sometimes  find  advantage  from 
spending  the  autumn  here. 

<r.  Marseilles. — This  city,  second  only  in  importance  to  Paris,  offers  no  residence 
for  the  invalid.  Pulmonary  consumption  annually  destroys  a  large  number  of  young 
women  and  men.  Catarrhs,  pleurisy,  and  pneumonia  are  common;  and  so  are  cuta- 
neous atfections,  diseases  of  the  generative  organs,  and  cancer. 

Mean  annual  temperature  58.32°  ;  winter  45.22,  spring  55.91,  summer  72.93,  and 
autumn  59.21.  Although  these  figures  are  high,  yet  the  winter  is  sliarpand  cold,  the 
winds  being  high  and  prevalent — especially  the  mistral  (northwest).  In  spring,  the 
variations  in  temperature  are  sudden  and  dangerous,  and  there  is  much  rain.  During 
summer  the  heat  and  dust  and  insects  are  intolerable. 

1.  Hyeres. — This  little  town  is  agreeably  situated,  about  two  miles  from  the  shores 
of  the  Mediterranean,  and  an  hour  and  a  half's  drive  from  Toulon.  The  climate  is 
clear,  pure,  dry,  and  tolerably  mild.  The  greater  portion  of  the  town  is  sheltered 
from  north  and  east  winds;  while  it  is  open  to  the  south,  benefiting  by  the  influence 
of  the  sun  and  :sea-breezes.  But  it  is  exposed  to  the  mistral,  as  there  are  no  protect- 
ing hills  on  the  northwest;  and  this  blows  frequently  during  the  first  three  months 
of  the  year.  It  has  been  thought  one  of  the  best  localities  in  the  South  of  France 
for  the  winter  abode  of  invalids  with  pulmonary  disease;  as  there  is  much  fine 
weather,  without  great  variations  in  temperature.  The  mornings  and  evenings, 
however,  are  cold  ;  and  hence,  remembering  too  the  prevalent  winds,  it  should  not 
be  recommended.  In  summer  the  heat  and  dust  prove  very  annoj-ing.  The  best 
season  is  during  April  and  May,  or  from  the  beginning  of  September  to  the  end  of 
November. 

^.  Cannes. — An  agreeable  sea-port,  on  the  shore  of  a  small  bay,  well  protected 
from  cold  winds.  It  has  a  climate  more  moist  and  sedative  than  Nice,  and  less  so 
than  Pau.     The  lower  parts  of  the  town  should  be  avoided,  as  the  drainage  is  bad. 


CLIMATES    FOR    INVALIDS.  369 

The  overworked  man  of  business,  seeking  fresh  air,  e^enial  sunshine,  and  a  locality 
possessins^  a  combination  of  tine  sea  and  mountainous  scenery,  may  advantaj^eousiy 
winter  here.  Cases  of  nervous  dyspepsia  are  jjarticularly  benefited,  and  so  arc  some 
forms  of  phthisis. 

Inthesumnu!r  Cannes  is  resorted  to  for  sea-bathina;,  the  extensive  sands  being 
well  adapted  for  this  purpose.  Sand  baths  are  sometimes  used  for  the  relief  of  rheu- 
matic and  (taralytic  atiections  of  the  limbs;  the  patients  being  immersed  up  to  the 
chest  in  sand  warmed  by  the  sun.  Like  mud  baths  they  may  serve  to  amuse  the 
invalid,  while  he  is  breathing  pure  air  and  living  by  rule. 

M.  Nice. — The  reputation  long  enjoyed-.vby  Nice  for  salubrity,  has  been  found  to 
have  been  greatly  overrated.  Protected  towards  the  interior  by  the  Maritinn;  AljiS 
and  the  Estreiles,  cooled  by  the  breezes  of  the  Mi'diterranean,  and  with  a  mild  dry 
climate,  it  would  seem  to  be  a  favorable  locality  for  phthisic'ul  j]atients.  JJut  not- 
withstanding these  advantages  the  valley  is  exposed,  during  winter  and  spring,  to 
cold  irritating  winds  from  the  east  and  northeast;  and  the  Nisands  tlusn  suffer  much 
from  catarrh,  ophthalmia,  skin  eruptions,  pneumonia,  and  irritable  gastric  affections. 
The  mean  temperature  for  the  year  is  59.U1°;  for  winter  46.38,  spring  55.92,  summer 
71.83,  and  autumn  61.62.  The  variations  between  the  warmth  of  night  and  day,  of 
sun  and  shade,  are  remarkable.  The  annual  rainfall  is  about  26  inches ;  most  fall- 
ing in  October  and  November,  leaving  the  other  winter  and  spring  months  compara- 
tively dry. 

M.  Carri^re  has  compared  the  valley  in  which  Nice  is  situated  to  an  open  fan,  the 
arch  of  which  is  formed  by  the  mountains,  and  the  point  by  the  shore,  where  the 
Var  discharges  itself  into  the  sea.  But  the  mountainous  semicircle  is  indented  in 
parts,  and  down  these  interruptions  the  winds  blow  from  certain  points,  and  inju- 
riously affect  consumptives. — The  mistral  is  "the  scourge  of  the  Mediterranean 
shores  of  Prance  and  Sardinia."  It  may  continue  one,  three,  seven  or  more;  days  at 
a  time;  in  autumn  and  winter  it  blows  frequently,  and  hence  it  is  absurd  for  inva- 
lids requiring  a  mild  temperature  and  calm  atmosphere  to  winter  at  Nice.  The 
southeast  wind,  or  sirocco,  so  injurious  on  the  continent  of  Italy,  becomes  changed 
into  a  mild  beneficial  breeze  during  its  transit  across  the  Mediterranean  to  Nice;  it 
modifies  winter  cold,  and  summer  heat  and  dryness.  La  Croix  de  Marbr-e,  the  suburb 
of  Nice  inhabited  by  the  English,  is  most  unfavorable  for  pulmonary  invalids;  it  is 
exposed  to  the  libeccio  (a  relaxing  southeast  wind),  and  to  the  blighting  influence  of 
the  mistral.  The  invalid  if  he  will  go  to  Nice  should  live  at  the  foot  of  the  heights, 
in  one  of  the  shady  valleys  open  to  the  south.  The  brilliant  sun  entices  him  out  of 
doors,  and  then  the  blighting  piercing  wind  attacks  him;  no  flannel  will  keep  out 
the  cold.  The  bills  of  mortality  of  the  Nisands  give  one-seventh  of  the  deaths  as 
from  phthisis.  That  "  Nice  is  one  of  the  last  places  to  which  a  foreigner  laboring 
under  tubercular  phthisis  should  resort,"  is  the  ojunion  of  Dr.  Burgess.  It  is  also 
unfavorable  for  nervous  and  susceptible  invalids.  The  air  may  sometimes  be  bene- 
ficial in  chronic  rheumatism  and  gout;  in  uterine  derangements  connected  with  a 
relaxed  and  torpid  state  of  the  system;  for  delicate  children  of  a  strumous  habit; 
and  for  invalids  returning  from  tropical  climates.  The  stay  should  extend  from  the 
middle  of  October  until  the  end  t)f  April.  The  author  has  been  told  that  there  are 
well-conducted  Pensions  both  at  Nice  and  Cannes  which  are  preferable  to  the  hotels 
as  being  more  quiet  and  home-like. 

9.  Villa  Franca. — This  little  town,  a  short  distance  from  Nice,  has  a  climate 
somewhat  warmer  and  drier,  and  is  less  exposed  to  the  north  and  northwest  winds. 
The  vegetation  is  luxuriant  and  early. 

/.  Mentone  — Lately  a  small  Italian  town,  but  annexed  to  France  in  1860,  Men- 
tone  otters  one  of  the  most  sheltered  stations  in  the  south  of  Europe.  It  is  situated 
on  the  northern  shore  of  the  Mediterranean,  at  the  foot  of  the  Maritime  Alps,  and 
twelve  or  thirteen  miles  to  the  east  of  Nice  on  the  road  to  Genoa.  The  bay,  in  the 
centre  of  which  the  town  is  placed,  is  completely  protected  from  the  north,  north- 
west or  mistral,  and  northeast  winds  by  the  mountains;  while  owing  to  the  absence 
of  fogs,  the  paucity  of  rain,  and  the  great  power  of  the  sun,  the  air  is  very  jileasant 
during  the  winter  months.  The  mean  temperature  is  a  little  higher  than  that  of 
Nice. 

From  the  beginning  of  November  until  the  end  of  April  the  climate  is  genial  and 
bracing.  The  invalid  must  not  remain  during  the  summer.  A  residence  here  is 
very  useful  in  phthisis,  when  the  disease  has  not  passed  beyond  the  first  stage  ;  and 
even  when  it  has  reached  the  second  or  third,  provided  the  tubercular  deposit  be 
limited  to  a  part  of  one  lung.  It  is  also  beneficial  in  chronic  cases  of  consumption  ; 
chronic  bronchitis;  and  chronic  gout  and  rheumatism.  Strumous  children  improve 
remarkably.     Some  who  visit  Mentone  prefer  the  eastern  bay,  some  the  western  ; 

24 


370  APPENDIX    OF   FORMULA. 

but  w'hichever  be  chosen,  care  must  be  taken  to  select  rooms  having  a  south  aspect, 
and  ^th  the  bedroom  not  on  the  ground  floor. — For  the  sake  of  those  who  are  not 
overburdened  with  wealth,  it  may  be  as  well  to  remember  that  Nice  and  Mentone 
are  both  extravagant  places,  while  San  Remo  is  much  cheaper,  and  the  air  is  just  as 
good  during  the  winter. 


444.   Corsica. 


This  island,  one  of  the  most  important  in  the  Mediterranean,  has  shores  mostly 
low,  while  the  centre  is  mountainous.  Dr.  Henry  Bennet  has  recommended  Ajac- 
Cio,  on  the  west  coast,  as  an  admirable  winter  station  for  invalids.  He  describes  it 
as  a  clean  and  cheerful  little  French  town,  with  quiet  sunny  streets;  and  which,  not 
being  cramped  in  by  walls,  has  spread  itself  out  on  the  northwest  side  of  a  beautiful 
bay  directed  due  south.  This  bay  is  protected  from  all  winds  but  the  southwest,  by 
its  hemicircle  of  grand  mountains  in  the  distance.  The  climate  is  as  warm  as  that 
of  Nice  (from  which  it  is  distant  some  eight  or  nine  hours'  sail  by  the  mail  steamer), 
and  it  is  unexceptionally  healthy. — Napoleon  Bonaparte  was  born  here,  15th  August, 
1769. 

Ajaccio  is  the  only  town  of  Corsica  that  appears  thoroughly  eligible  as  a  winter 
residence.  The  climate  of  Bastia  is  warm  and  agreeable;  but  the  town  has  a  small 
tideless  port,  and  is  exposed  both  to  southeast  and  northeast  winds.  Dr.  Manfredi, 
the  surgeon  of  the  civil  hospital  at  Bastia,  states  that  nearly  all  surgical  wounds  heal 
at  once  by  first  intention,  while  purulent  absorption  is  almost  unknown. — Corsica 
should  be  avoided  in  the  autumn,  on  account  of  the  malaria  which  then  prevails  in 
many  parts. 


445.  Spain  and  Portugal. 

It.  Alicante. — Lying  along  the  shore  of  a  bright  open  bavin  the  Mediterranean, 
is  this  healthy  town.  It  is  sheltered  on  the  north  and  northwest  sides  by  a  lime- 
stone rock  some  700  feet  high,  is  free  from  malaria,  and  has  a  mild  dry  air  with  com- 
parative immunity  from  high  winds.  The  mean  annual  temperature  is  63.7",  that 
for  winter  being  52.1.  The  rainfall  is  very  moderate.  In  summer  the  calm  open 
sea,  and  sandy  beach,  afford  good  bathing.  In  winter,  whatever  may  be  the  temper- 
ature of  the  morning  air,  the  middle  and  after-part  of  the  day  will  genei-ally  be 
mild  and  calm. 

As  a  winter  residence  it  may  be  recommended  to  such  as  need  a  dry  and  somewhat 
stimulating  climate.  It  has  been  found  useful  in  chronic  bronchitis,  with  excessive 
secretion  ;  as  well  as  in  atonic  dyspepsia. 

/3.  Barcelona. — This,  the  chief  city  of  Catalonia  and  the  second  in  importance 
of  Spain,  has  a  mild  winter  air.  It  is  open  to  the  sea  on  the  south  and  southwest, 
and  is  partially  protected  from  westerly  and  northerly  winds  by  the  hills  at  the  back. 
The  mean  annual  temperature  is  68.14",  that  of  winter  being  50.18;  while  there  is 
rain  on  some  69  days  in  the  year.  Invalids  requiring  a  rather  stimulating  and  dry 
climate  may  reside  here,  but  it  cannot  be  strongly  recommended.  April  and  May 
are  the  most  uncertain  months. 

y.  Cadiz. — The  semi-insular  position  of  this  commercial  town,  on  the  shores  of 
the  Atlantic,  would  seem  to  point  it  out  as  a  suitable  winter  residence  for  those  re- 
quiring sea-air.  The  climate  is  soft,  humid,  and  relaxing  ;  the  winters  are  mild  and 
the  summer  temperate  ;  the  weather  is  showery,  especially  in  winter  and  autumn,  but 
the  soil  being  |»orous  it  soon  dries;  and  there  are  few  days  during  winter  on  which 
exercise  cannot  be  taken  in  the  open  air.  The  mean  annual  temperature  is  62.76°  ; 
that  for  winter  being  52.80,  though  very  often  at  this  season  the  thermometer,  in  the 
shade,  will  stand  at  above  60.  Kain  falls  on  about  100  days  in  the  year  ;  but  it  gener- 
ally comes  in  showers,  with  intervals  of  sunshine. 

This  town  may  be  recommended  for  some  irritable  atfections  of  the  chest,  and  in 
certain  cases  of  heart  disease.  Women  with  any  tendency  to  ovarian  or  uterine  dis- 
orders should  avoid  Cadiz.  The  stranger  will  find  it  best  to  reside  in  the  central 
portion  of  the  town, — as  on  the  sunny  side  of  the  square  of  G-eneral  Mina  or  San 
Antonio,  or  in  one  of  the  lesser  plazas.  The  wall  (Muralla  del  Mar)  which  nearly 
surrounds  the  town  has  on  its  summit  an  agreeable  walk. 

i.  Madrid. — The  capital  of  Spain,  situated  nearly  in  the  centre  of  the  Peninsula, 


CLIMATES    FOR    INVALIDS.  371 

is  perhaps  an  attractivn  city  for  the  tourist ;  but  the  irritatincj  and  stimulatinqrchar- 
acter  of  the;  climate  rcrulcrs  it  an  unf'avoriiljio  one  tor  the  Kni^lisli  invalid.  The 
mean  annual  temperature  is  57"  ;  but  the  ran<(e  is  so  great  that  Dv.  Francis  has  ob- 
served a  thermometer  ])ointing  to  below  freezing  a  little  after  sunrise,  stand  at  106 
at  3  P.M. — Tlie  winters  are  raw  and  long,  with  hard  frosts  and  piercing  cold  winds  ; 
in  summer  the  heat  is  irritating  and  oppressive,  so  that  even  the  Spaniards  cannot 
stand  it, — "  The  subtle  air,"  .says  Ford,  in  his  Handbook,  "  which  will  not  extinguish 

a  candle,  puts  out  a  man's  life No  wonder,  according  to  Salas,  that 

even  the  healthy  of  those  born  there  live  on  physic." 

t.  Malaga. — Dr.  Francis  speaks  very  highly  of  Malaga,  which,  indeed,  seems  to 
be  the  El  Dorado  of  cities;  for  he  asserts  tliat  there  is  no  place  in  Spain,  nor  in  the 
whole  of  Europe,  as  far  as  our  present  information  goes,  that  po.ssesses  a  climate  at 
once  so  mild  and  equable,  with  so  little  variation  from  day  to  day.  This  seaport  city  is 
situated  on  a  bay  of  the  Mediterranean,  G5  miles  east-northeast  from  Gibraltar.  The 
mean  annual  temperature  is  66.11",  that  of  winter  being  .54.41  ;  the  heat  of  .January 
corresponding  with  that  of  May  in  London.  The  air  is  neither  too  moist,  nor  too 
dry  ;  and  a  lofty  mountain  range  forms  a  protecting  background  to  the  winter  winds. 
The  annual  rainfall  is  said  to  be  only  16^  inches. 

The  longevity  of  the  people  is  remarkable ;  persons  aged  from  80  to  90  being  seen 
going  about  the  streets  in  full  possession  of  all  their  faculties.  Though  the  ratio  of 
mortality  is  1  in  37,  yet  it  must  be  remembered  that  this  is  larger  than  it  would  other- 
wise be  ;  not  only  from  the  excessive  mortality  in  early  life  (42.3  per  cent,  during  the 
first  five  years)  owing  to  the  mothers  not  nursing  their  infants,  but  likewise  from 
the  presence  in  the  town  of  a  large  garrison  and  a  crowded  convict  establishment. 
The  principal  drawback  seems  to  be  the  terral,  a  cold  harsh  wind  from  the  north- 
west, which  occasionally  blows  during  the  winter  with  great  force.  It  causes  rest- 
lessness, and  oppression  at  the  chest,  where  there  is  any  pulmonary  atlection.  The 
air  is  also  unfavorable  in  cases  of  disease  of  the  nervous  centres. 

The  invalid  who  requires  a  warm,  dry,  and  gently  tonic  climate,  with  constant 
sunshine,  may  well  visit  Malaga  for  the  winter.  A  residence  here  is  especially  use- 
ful when  phthisis  seems  to  threaten,  or  even  when  it  is  present  in  an  early  stage.  He 
should  live  in  the  newer  part  of  the  town,  where  the  soil  is  sandy,  and  through  the 
centre  of  which  runs  the  Alameda,  a  fine  broad  promenade  bordered  by  cheerful 
well-ventilated  houses.  The  Spanish  custom  of  taking  a  siesta  in  the  middle  of  the 
day  ought  to  be  adopted.  There  is  a  regular  steam  communication  with  Liverpool, 
the  voyage  lasting  seven  or  eight  days. 

^.  Valencia. — This  city,  built  upon  the  great  plain  of  Valencia,  is  about  three 
miles  from  the  sea.  It  may  be  reached  in  seven  days  from  England,  by  way  of  Mar- 
seilles.— The  town  is  very  clean,  the  climate  unusually  dry,  though  the  water  evap- 
orated by  the  system  of  irrigation  pursued  impregnates  the  air  with  moisture  ;  there 
are  no  cold  fogs  ;  the  wind  is  soft  and  mild  during  winter,  in  summer  refreshingly 
cool ;  and  the  mean  annual  temperature  is  63.5",  that  of  winter  being  49.7.  The  cold 
is  often  appreciable  in  early  morning  and  after  sunset  during  winter,  but  it  is  warm  by 
mid-day.  The  springtime  is  the  best — from  the  middle  of  February  till  the  begin- 
ning of  May:  autumn  is  to  be  avoided  owing  to  the  miasmata  from  the  rice-planta- 
tions.— Consumption  is  not  uncommon  among  the  poor ;  but  then  in  no  part  of  Spain 
does  the  laborer  work  harder,  or  subsist  on  a  more  meagre  diet. 

Useful  for  the  overworked  man  of  business,  semi-invalids  and  hypochondriacs, 
individuals  with  impaired  health  but  no  organic  disease,  gout  and  rheumatism,  cal- 
culous aft'ections,  albuminuria,  and  nervous  dyspepsia.  There  are  several  towns 
within  easy  reach  of  Valencia  where  the  invalid  may  go  for  a  short  stay, — such  as 
Alcira,  Carcaje?ite,  Jativa,  San  Felipe,  ^'c. 

».  Seville. — The  famous  capital  of  Andalusia,  and  the  city  of  Figaro,  possesses  a 
soft  and  tonic  climate.  It  may  be  visited  by  the  hypochondriac,  by  convalescents 
from  lingering  disease,  &c.  ;  or  the  invalid  who  has  wintered  in  Malaga  might  ad- 
vantageously stay  here  during  May.  The  best  part  of  the  year  is  from  November  to 
March.  There  is  considerable  rain  in  October,  November,  and  April.  Occasionally 
during  the  summer  the  sultry  and  irritating  levante  or  east  wind  prevails,  giving  rise 
to  fever,  ophthalmia,  mental  irritability,  and  neuralgic  atl'ections. 

6.  Aranjuez. — Situated  24  miles  south  of  Madrid,  on  the  left  bank  of  the  Tagus. 
The  season  consists  of  April  and  May,  during  which  months  the  climate  is  soft  and 
most  agreeable.  The  water  of  the  town  contains  a  little  sulphate  of  soda,  and  hence 
is  sometimes  aperient  if  taken  largely. 

/.  Lisbon. — The  capital  of  Portugal  has  a  dry  and  bracing  climate ;  though  the 
changes  from  sunshine  to  rain,  from  heat  to  cold,  are  sudden  and  remarkable.    Hence 


372  APPENDIX    OF    FORMULA. 

it  is  not  to  be  recommended  for  pulmonary  invalids ;  while,  moreover,  phthisis  is 
very  prevalent  among  the  inhabitants. 

The  mean  annual  temperature  is  about  62.00" ;  that  for  winter  being  52.52,  spring 
59.66,  summer  70.94,  and  autumn  62.48.  The  annual  rainfall  is  23  inches,  most  wet 
days  occurring  in  winter.  The  predominating  winds  are  those  from  northeast  to 
southeast,  and  to  them  is  due  the  cold  of  winter. 

Dr.  Francis  says  that  the  best  situation  for  an  invalid  who  wishes  to  pass  the  win- 
ter in  Lisbon,  is  the  upper  part  of  the  Val  de  Pereiro  ;  a  contituuition  of  the  valley  in 
which  the  new  part  of  the  town  and  the  public  gardens  lie.  "  Here,  upon  the  southern 
slope  of  the  hill,  are  a  few  villas  in  the  midst  of  orange  gardens,  which  are  well-shel- 
tered, and  afford  choice  views  over  the  town  and  river.  Those  who  prefer  a  country 
residence,  may  select  the  neighborhood  of  Bemficn,  a  village  on  the  Cintra  road,  about 
a  league  from  Lisbon.  This  place  is  in  high  reputation,  among  the  Portuguese  phy- 
sicians, for  the  purity  of  the  air,  and  it  is  here  they  send  their  convalescents." 

K.  Cintra. — A  summer  residence  of  the  court  and  wealthy  inhabitants  of  Lisbon, 
from  which  it  is  only  sixteen  miles  distant.  Frequent  breezes,  a  humid  soil,  and  an 
abundance  of  vegetation  render  the  summer  air  cool  and  healthy.  The  winters  are 
wet  and  cheerless. 


446.    Gibraltar. 

This  strongly  fortified  portion  of  the  British  possessions,  occupies  a  mountainous 
promontory  near  the  southern  extremity  of  Spain,  at  the  entrance  of  the  Mediter- 
ranean. The  town  is  built  on  the  western  aspect  of  the  rock.  It  is  unsuitable  as  a 
residence  for  invalids.  For  though  the  average  winter  temperature  is  57.93°,  yet  the 
southeast  wind^the  levante— renders  the  locality  cold,  raw,  and  verj^  unpleasant. 
Snow  and  ice  are  very  rare,  but  there  is  considerable  rain.  The  annual  rainfall  is 
43  inches. 


447.  Italy. 

a.  Lago  Magqiore. — The  largest  of  the  lakes  of  Northern  Italy.  Along  its  shores 
are  small  towns  resorted  to  by  English  invalids  in  summer.  Baveno,  Arona,  and 
Sesfo  are  the  most  frequented.  But  the  climate  though  clear  and  pure  is  often  marred 
by  the  violent  thunder-storms  which  prevail  in  summer;  there  are  heavy  dews  at 
night;  while  the  neighboring  glaciers  make  it  cold  when  the  wind  blows  from  that 
quarter.  T\w  air  is  injurious  to  phthisical  invalids,  but  useful  in  general  debility,  in 
d^'spepsia,  and  for  such  as  need  a  cool  tonic  atmosj)here. 

yg.  Lake  of  Como. — Situated  at  the  northeast  of  Milan,  from  which  it  is  not  far 
distant. — The  air  is  genial  and  mild,  the  temperature  equable,  and  the  heat  not  op- 
pressive owing  to  the  alternate  play  of  the  tivano  or  north  wind  during  the  night, 
and  the  breva  or  south  wind  in  the  day.  For  ordinary  invalids  in  summer  the  best 
situations  on  the  lake  are  Balbianino^  Torno,  and  Bellngio ;  but  for  the  consumptive 
Vare.na  is  more  suitable.  Cadenabbia.  and  Tremezzlne,  on  the  shore  near  the  middle 
of  the  lake,  are  very  beautiful  spots;  while  according  to  Dr.  Burgess,  Plinia7ia,  the 
most  noted  spot  along  these  classic  shores,  the  supposed  residence  of  Pliny,  will  not 
jield  precedence  to  either  in  climate  or  situation.  The  cold  in  the  winter  is  great, 
especially  at  the  northern  extremity  of  the  lake. — No  part  of  Italy  perhaps  is  so  suit- 
able for  the  c()nsum])tive  in  sum nuu-,  as  the  Lake  of  Como.  That  dreadi'd  disease 
pellagra,  a  kind  of  leprosy,  is  not  uncommonly  seen  here.  From  one-third  to  a 
fourth  of  the  lunatics  in  the  Lombardy  Asylum  are  suffering  from  it,  for  it  induces 
insanity;  while  many  cases  of  it,  in  early  stages,  are  to  be  found  in  the  hospitals. 

■y.  Milan. — This  city,  the  capital  of  the  Lombardo-Venetian  kingdom  until  1859, 
when  it  was  made  over  to  Sardinia,  is  situated  in  a  fertile  }i]ain  between  the  Ohma 
and  Saveso  rivers,  at  an  elevation  of  394  feet  above  the  Adriatic.  It  is  indifferently 
sheltered  from  the  various  winds,  so  that  the  climate  is  cold  ;  snow  and  rain  are  fre- 
quent during  the  winter;  while  the  sudden  transitions  from  humidity  to  a  dry  harsh 
air,  render  it  an  unfavorable  locality  for  any  but  the  strong.  It  is  frequented  by 
consumptives  going  to,  or  returning  from  the  south  of  Italy  ;  but  the  shorter  their 


CLIMATES    FOR    INVALIDS.  373 

stay,  thfi  bpttor.     In  1831,  ofRcial  returns  showed  that  amongst  the  Milanese  alone, 
20,000  individuals  were  attacked  by  pellagra. 

(T.  BiiK.sciA,  Pavia,  Vekona,  and  Mantua. — The  principal  towns  of  Lonibardy, 
arc  all  pjirticularjy  unsuitable  for  invalids.  Agues,  fevi^rs,  and  inHaininati'Uis  aie 
very  common.  The  cold  in  winter  is  intense  ;  the  atmosphiu'e  is  saturatcid  with  moist- 
ure; there  are  dense  clouds  and  fogs  ;  there  are  large  quantities  of  rain,  in  the  form 
of  a  tine  continuous  drizzle;  and  cold  winds  are  very  prevalent,  especialiy  the  north- 
east. 

6.  Venice. — This  city,  the  Queen  of  the  Adriatic  of  the  poets,  is  built  on  piles  in 
midst  of  a  lagoon  or  large  marsh,  two  miles  from  the  mainland  of  the  (Continent.  It 
would  seem  to  be  slowly  crumbling  to  decay.  The  climate  is  mild  and  Cfpiabic^ ;  the 
air  bfjing  impregnated  with  emanations  of  bromine  and  iodine.  Consumption  is 
prevalent  among  the  inhabitants.  Invalids  are  not  attracted  to  Venice  by  the  cli- 
mate, however,  but  by  its  historical  associations,  and  many  sickly  persons  are  to  be 
found  on  the  favorite  promenade — the  Piazza  of  St.  Mark.  The  mean  temperature 
of  winter  is  about  39°  F.,  of  spring  54,  summer  73,  and  autumn  55.  Drizzling  rain 
soin(!tim(^s  falls  for  days  togcllu^r.  The  result  of  seven  years'  observation  gave  a 
mi'Mii  of  5J  days  of  snow  in  winter. — In  Venice  the  dolce  fiir  niente  practici^  is  fully 
carri(>d  out ;  the  climate  being  favorable  to  indolence  and  voluptuous  ease.  Contrary 
to  what  might  be  expected  ague  is  unknown.  The  tranquillity  which  prevails  over 
the  city  is  not  unfavorable.  As  the  climate  is  sedative  and  lowering,  it  is  not  fit  for 
those  who  are  depressed  by  disease ;  and  except  in  the  early  stage  it  is  injurious  to 
phthisical  patients.  It  is  suitable  for  such  as  have  a  tendency  to  inflammation,  ha?m- 
optysis,  &c.  Invalids  may  remain  here  from  the  close  of  autumn  to  the  end  of  spring  ; 
but  it  is  most  agreeable  in  the  latter  season. 

^.  Genoa. — This  town,  at  the  head  of  the  Gulf  of  Genoa,  is  one  of  the  last  places 
for  a  consumptive  to  pass  any  time  at.  The  vicissitudes  of  temperature  are  rapid 
and  extensive ;  there  are  sudden  gusts  of  wind ;  while  the  biting  coldness  of  the  tra- 
montana  or  north  wind,  alternating  with  the  warmth  and  humidity  of  the  ijirocco  or 
southeast,  the  two  prevailing  winds  of  Genoa,  proves  very  trying.  The  best  time  for 
a  visit  to  Genoa  (not  by  a  consum})tive)  is  about  the  autumn  or  the  beginning  of 
summer.  Pneumonia,  hemoptysis,  consumption,  and  catarrh  are  amongst  the  most 
frequent  diseases  of  the  inhabitants. 

n.  Florence. — Situated  on  the  Arno,  a  few  hours'  ride  from  Pisa,  this  city  may  be 
an  agreeable  residence  for  the  very  strong.  But  certainly  in  no  part  of  England 
could  a  more  unfavorable  climate  be  found  for  consumptives.  It  is  built  in  a  deep 
ravine,  almost  surrounded  by  the  Apennines,  and  intersected  by  a  squalid  river.  It 
is  one  of  the  stations  on  the  western  zone  of  Italy  where  it  rains  the  most.  Extreme 
cold  in  winter,  great  heat  in  summer,  chilling  northerly  winds,  occasional  fogs,  vio- 
lent atmospheric  and  thermal  variations, — these  are  its  chief  peculiarities  in  a  sanitary 
point  of  view.  The  nervous  excitability  of  Florentines  is  explained  by  the  topogra- 
phy of  the  city.  As  the  birthplace  of  Dante,  Leonardo  da  Vinci,  Machiavelli,  &c., 
as  well  as  for.  its  churches,  palaces,  and  magnificent  works  of  art,  it  oilers  many  at- 
tractions to  the  tourist. 

fl.  Pisa. — The  dismal  aspect  of  this  neglected  city  surpasses  that  of  any  otlier  in 
Italy.  The  dreary  solitude  of  the  streets  causes  gloom  and  melancholy  ;  while  every- 
thing seems  stricken  with  decay  or  death.  It  is  often  recommended  for  consumptive 
invalids;  but  the  climate  is  mainly  indebted  to  tradition — being  mild,  humid,  and 
relaxing.  The  sky  is  dull  and  often  murky.  Perhaps  the  high  walls  around  Pisa 
assist  in  protecting  portions  of  it  from  the  cold  winds,  especially  the  Lung'  Arno,  or 
that  quarter  where  the  invalids  reside.  The  mean  temperature  of  winter  is  about  45°, 
spring  59,  summer  74,  and  autumn  63.  The  winter  is  colder  than  at  Rome.  The  air 
is  moist  from  the  great  prevalence  of  southerly  and  Mediterranean  winds.  The  cli- 
mate is  very  depressing — causing  general  lassitude  while  it  enervates  the  faculties. 
Many  foreign  invalids  die  within  a  few  weeks  of -their  arrival.  Haemoptysis  fre- 
quently sets  in  where  there  is  any  tendency  to  phthisis. 

/.  Rome. — Situated  on  marshy  ground  at  the  foot  of  a  range  of  low  hills,  about  four- 
teen miles  from  the  sea,  and  divided  by  the  Tiber  into  two  unequal  portions,  Rome 
has  not  so  much  to  recommend  it  to  those  really  in  search  of  health  as  many  other 
places.  The  climate  is  mild,  soft,  and  sedative;  but  malarious  effluvia,  in  a  greater 
or  less  degree,  are  never  absent.  The  best  time  in  the  year  is  October  and  the  first 
ten  days  of  November.  The  mean  annual  temperature  is  60.49°  ;  that  of  winter  being 
46.75,  spring  58.25,  summer  74.24,  and  autumn  62.75.  Owing  to  its  exposure  to  cold 
winds,  the  variations  in  temperature  are  great  and  sudden.  Northerly  wi?i(ls  are  com- 
mon in  the  morning  and  evening,  though  in  the  middle  of  the  day  the  wind  blows 


374  APPENDIX    OF    FORMULA. 

from  the  south.  The  tramontana  is  cold  and  searching  ;  but  the  prevalent  wind  is 
the  sirocco  from  the  southeast,  which  is  hot,  sometimes  dry,  and  sometimes  so  moist 
as  to  render  the  streets  slippery  and  damp.  Under  its  influence  the  tissues  relax,  ap- 
petite fails,  bowels  become  torpid,  spirits  flag,  and  the  weakly  get  oppressed  with 
lassitude  and  headache.  If  an  invalid  will  go  to  Eomo  in  the  winter,  let  him  spend 
as  much  time  as  he  can  in  St.  Peter's.  No  other  public  building  can  compare  with 
this  church  as  regards  possessing  a  dry  equable  temperature  all  the  year  round.  The 
mild  genial  air  in  its  interior  is  so  prized,  that  the  sickly  meet  and  promenade  in  St. 
Peter's  when  the  weather  will  not  permit  of  exercise  in  the  open  air. 

Dr.  Burgess  entertains  a  very  unfavorable  opinion  of  the  sanitary  value  of  this  city. 
And  he  points  out  that  the  popular  feeling  in  favor  of  a  mild  and  relaxing  climate 
for  consumption  is  altogether  wrong,  being  based  upon  erroneous  data,  if  not  upon 
mere  tradition.  A  cold  climate,  such  as  that  of  Norway  or  of  Canada,  and  still  air, 
are  evidently  more  rational  indications,  if  the  formation  of  tubercle  is  the  result  of  a 
relaxed  state  of  the  vital  functions,  involving  impaired  digestion,  depraved  nutrition, 
and  degeneration  of  the  blood.  Nothing  is  more  calculated  to  derange  the  digestive 
organs  than  the  sedative  influence  of  a  malarious  atmosphere.  The  mild  climate 
aliays  bronchial  irritation,  at  the  expense  of  the  general  health  and  of  disordered 
nutrition. 

The  most  fitting  localities  in  the  city  for  the  invalid  with  any  bronchial  irritation, 
chronic  rheumatism,  &c.,  are  the  north  and  west  sides  of  the  Piazza  di  Spagna,  as 
having  a  southern  exposure :  or  he  may  choose  one  of  the  streets  running  east  and 
west  from,  and  near  to,  the  Piazza, — the  Strada  de'  Condotti,  Strada  della  Croce, 
Strada  Frattina,  &c.,  the  north  sides  of  which  gain  the  southern  sun,  and  all  of  which 
are  on  sheltered  ground.  The  south  side  of  the  Strada  del  Corso  should  be  avoided, 
as  the  Tiber  frequently  overflows  in  winter,  generating  low  fever,  &c.  The  Piazza 
del  Pojiolo  is  also  subject  to  damp  fogs.  In  most  cases  the  second  and  third  floors  of 
a  house  are  preferable  to  the  first;  since,  owing  to  the  narrowness  of  the  streets,  they 
are  more  exposed  to  the  sun.  The  higher  and  more  exposed  ground  of  the  Monte 
Pincio,  Via  Sistina,  Piazza  Barberina,  &c.,  is  suitable  for  those  with  healthy  chests, 
and  who  can  bear  a  high  wind. — The  stay  may  extend  from  October  till  the  end  of 
May. 

K.  Naples. — The  climate  somewhat  resembles  that  of  Nice,  but  is  more  variable 
and  humid.  Situated  on  the  northern  shore  of  the  Bay  of  Naples,  on  the  slopes  of  a 
range  of  hills,  near  the  foot  of  Vesuvius,  this  city  seems  to  ofter  all  that  is  charming 
to  the  man  in  health,  and  everything  that  is  pernicious  to  the  invalid.  The  mean 
annual  temperature  is  60.26°;  winter  being  47.65,  spring  57.56,  summer  74.38,  and 
autumn  61.46.  Besides  other  winds,  it  is  exposed  to  the  sirocco  or  southeast,  which 
is  enervating  to  both  body  and  mind ;  as  well  as  to  the  mistral  or  northwest,  which 
brings  raw  piercing  cold  and  damp.  Catarrh,  pneumonia,  phthisis,  rheumatism, 
ophthalmia,  uterine  disease,  and  cutaneous  aft'ections  are  common  amongst  the  inhab- 
itants. Eustace  says,  and  apparently  with  reason, — "  If  a  man  be  tired  of  the  slow 
lingering  process  of  consumption,  let  him  repair  to  Naples  ;  and  the  denouement  will 
be  much  more  rapid."  Indeed,  so  fatal  is  the  climate  to  invalids  with  pulmonary 
disease,  especially  during  the  winter,  that  the  proverb, — "  Vedi  Najwli  e  po'  mori," 
may  be  interpreted  in  a  more  literal  sense  than  that  intended. 

•y.  V>AXM  AND  PozzTJOLi. — Situated  in  the  vicinity  of  Naples,  these  towns  are  rec- 
ommended by  M.  Carrifere  as  winter  residences  for  invalids  already  sojourning  in 
the  Neapolitan  territory.  The  air  is  humid  and  warm,  and  little  disturbed  by  violent 
winds.  But  the  undrained  swamps  in  the  neighborhood  of  Baias,  and  the  fatality  of 
phthisis  at  Pozzuoli  ought  to  deter  any  invalid  from  leaving  England  for  these  sta- 
tions of  classic  renown,  however  anxious  he  might  be  to  escape  to  them  from  Naples. 


448.    The  Ionian  Islands. 


This  group  of  islands  in  the  Mediterranean,  otFthe  west  coast  of  Greece  and  Epirus, 
ceded  to  the  Greeks  by  Great  Britain  in  1868,  consists  of  Corfu,  Cephalnnin,  Znnfe, 
Santo,  Maura,  Ithaca,  with  many  smaller  islands.  Their  surfaces  are  mountainous 
and  rugged,  but  in  some  of  the  larger  islands  are  fertile  plains.  They  vary  but  little 
in  climate  ;  the  winters  being  stormy  and  wet  with  northerly  winds,  the  springs  warm, 


CLIMATES   FOR   INVALIDS.  376 

and  the  summors  dry  and  hot.  Intormittcnt  and  remittent  fevers,  dysentery  and 
diarrlicea,  phthisis  and  pneumonia  are  prevalent.  As  a  tour  for  the  hypochondriac 
a  visit  to  tliese  islands  may  be  recommended. 


449.  Malta. 

Of  an  area  not  much  exceeding  that  of  the  Isle  of  Wight,  this  island  forms  the  chief 
station  of  the  British  fleet  in  the  Mediterranean,  and  is  daily  called  at  by  ships  of  all 
nations.  The  atmosphere  is  clesir  and  bright,  the  annual  rainfall  about  15  inches,  the 
air  mild  and  bracing  in  winter,  and  the  temperature  equable  with  a  yearly  average 
of  about  i'A^.  Heavy  gales  of  wind  are  not  very  frequent,  though  the  atmosphere  is 
never  entirely  calm.  The  gregale  or  northeast  wind  is  cold  in  winter,  and  often  does 
damage  in  the  harbor  of  Valetta ;  while  the  sirocco  or  southeast  prevails  especially 
in  August  and  September,  is  hot  and  humid,  and  produces  lassitude  with  debilitj'. 

The  Rev.  James  Sherman,  who  suffered  from  consumption,  writing  from  Malta 
on  the  16th  January,  1861,  said, — "A  blazing  sun  shoots  his  rays  into  my  room,  and 
a  delicious  breeze  makes  it  sufficiently  cool.  I  look  out  on  a  sort  of  Regent  Square — 
people  traversing  up  and  down  in  crowds — a  beautiful  garden  opposite  my  window, 
with  hundreds  of  oranges  on  the  trees — priests,  beggars,  and  guides  jostling  one 
another  in  every  direction — a  side  view  of  the  ocean — a  deep  blue  sky,  without  a 
cloud — and  at  night  the  stars  looking  so  large,  near,  and  brilliant,  that  I  can  scarcely 
believe  I  am  only  4.^  days  from  the  frost  and  snow  of  England.  The  climate  seems 
most  delicious,  and  well  adapted  to  invalids." 

The  weather  is  most  agreeable  from  the  middle  of  October  until  the  end  of  Janu- 
ary. Asthma  connected  with  chronic  bronchitis,  atonic  dyspepsia,  strumous  glandu- 
lar swellings,  and  deranged  health  from  overwork, — these  are  the  cases  which  are 
most  likely  to  be  benefited  by  a  stay  i^  the  cheerful  bustling  capital  of  Valetta. 


450.  Egypt. 

One  of  the  earliest  civilized  localities  of  the  world,  this  country  has  long  been 
divided  into  the  provinces  of  Said  or  Upper  Egypt,  Vostani  or  Middle  Egypt,  and 
BaJiari  or  Lower  Egypt.  Upper  and  Middle  Egypt  are  more  healthy  than  the  Delta. 
There  are  only  two  seasons  in  Egypt, — the  temperate  from  October  to  March,  and 
the  hot  from  March  to  October.  At  Cairo,  the  capital,  the  climate  is  healthy,  little 
variable,  and  dry  ;  the  mean  temperature  of  the  year  being  72.2°,  while  that  of  winter 
is  58.5,  and  of  summer  85.1.  Taking  the  whole  of  Egypt,  the  mean  temperature  in 
December,  January,  February,  and  March,  may  be  said  to  be  about  the  same  as  that 
of  this  country  in  June,  July,  and  August. 

The  invalid  should  leave  England  rather  early  in  October,  so  choosing  his  time  of 
sailing  by  one  of  the  Peninsular  and  Oriental  Company's  steamers,  as  to  be  alile  to 
see  the  best  spots  on  the  south  coasts  of  Spain  and  Portugal,  Gibraltar,  and  INIalta. 
This  arrangement  will  usually  be  preferable  to  that  of  beginning  the  voyage  at  Mar- 
seilles. From  Malta  to  Alexandria  occupies  only  a  few  days  :  the  traveller  ought  to 
arrive  at  the  latter  by  the  middle  of  November.  Leaving  this  port  as  soon  as  "  the 
sights"  are  visited,  he  proceeds  to  Cairo  by  railway  ;  whence  ho  begins  to  ascend  the 
Nile,  so  as  to  reach  Thebes  by  the  beginning  of  December.  The  climate  of  Thebes 
is  all  that  the  valetudinarian  can  desire  ;  and  hence  he  may  either  remain  there,  or 
proceed  southerly  in  the  direction  of  Nubia.  But,  however  far  his  trip  may  extend, 
he  should  be  back  in  Cairo  by  the  end  of  March  ;  whence  he  may  arrange  his  home 
journey,  by  way  of  Greece  and  Constantinople,  so  as  to  be  in  England  by  about  the 
latter  part  of  June. 

The  necessity  for  travelling  by,  and  living  in  boats  after  leaving  Cairo,  has  of  course 
certain  disadvantages,  and  is  somewhat  expensive.  But  with  a  dry  balmy  atmosphere, 
and  a  sky  bright  and  cloudless,  the  invalid  may  find  much  that  is  most  agreeable  and 
exhilarating  in  the  even  progress  of  a  Nile  boat — a  dahabeeh. — The  two  chief  annoy- 
ances to  the  traveller  in  Egypt  are  the  dust,  and  "  Baksheesh."  The  former  may  be 
mitigated  by  suitable  clothing, — mohair  dresses  for  ladies,  and  flannel  shirts  with 


376  APPENDIX    OF   FORMULA. 

tweed  suits  for  gentlemen ;  while  the  latter  must  be  avoided  by  not  exhibiting  too 
much  liberality,  and  by  bargaining  beforehand  with  dragomen,  guides,  coachmen, 
boatmen,  «&c.  The  climate  may  especially  be  recommended  in  the  early  stages  of 
tuberculosis,  in  chronic  bronchitis,  some  forms  of  humoral  asthma,  gout,  and  rheu- 
matism, renal  diseases,  dyspepsia,  and  affections  of  the  nervous  system. 


451.  Algiers. 

The  city  of  Algiers,  the  capital  of  an  extensive  country  of  Northern  Africa  border- 
ing on  the  Mediterranean,  has  been  much  resorted  to  by  invalids.  It  can  be  reached 
easily  in  seven  or  eight  days  from  London  ;  by  way  of  Folkestone,  Paris,  Lyons,  Mar- 
seilles, and  thence  by  steamer  in  forty-eight  hours.  About  the  end  of  October  is  the 
best  time  for  thp  invalid's  arrival  on  the  coast  of  Africa  ;  the  great  heat  having  then 
usually  ceased,  and  the  first  rains  having  refreshed  the  lands,  so  that  the  country  has 
the  appearance  of  spring. 

Speaking  of  this  city,  Dr.  Mitchell  says  that  with  difficulty,  if  at  all,  will  the  Eu- 
ropean traveller  find  a  spot  on  earth  where  natural  beauties  so  combine  with  those  of 
man's  creation  to  please  and  interest  him.  One  of  the  long  sides  of  the  oblong  of 
which  the  "  Place  du  (rouvernement"  is  formed,  is  open  to  the  sea ;  commanding  a 
view  of  the  bay,  the  harbor,  the  peaks  of  the  distant  Atlas,  and  the  verdure  of  the 
Sahel  slopes.  The  "Place"  itself  is  filled  with  a  strange  mixture  of  all  races;  the 
Arab,  the  Moor,  the  turbaned  Jew  of  Africa,  the  Maltese  fisherman,  the  Spanish 
fruitseller,  the  veiled  women  of  Moslem,  the  picturesque  Jewess,  the  pretty  Spaniard, 
«fec.,  «&c.  The  invalid  will  find  objects  of  interest  without  seeking  them,  and  will  be 
gratified  and  amused  merely  by  wandering  in  the  open  air. — The  mean  annual  tem- 
perature is  about  66.50°  Fahr.  The  mean  temperature  for -each  season  is — winter, 
56.91 ;  spring,  67.60;  summer,  77.73;  and  autumn,  63  80.  The  rainfall  is  36  inches: 
rainy  days,  96.  Winter  fogs  are  rare.  Snow  has  fallen  once  in  seven  years.  Com- 
pared with  other  points  on  the  Mediterranean,  Algiers  has  a  warmer  and  a  less  vary- 
ing climate  than  Marseilles,  Wice,  Genoa,  and  Naples;  while  it  more  nearly  ap- 
proaches, but  is  still  superior  to  Malta,  Corfu,  and  Gibraltar. — Dr.  Mitchell  quotes 
the  opinions  of  M.  Odrultz,  which  are  to  the  following  efi'ect:  1st,  the  climate  of 
Algiers  is  opposed  to  the  generation  as  well  as  to  the  evolution  of  tubercle  in  the 
lungs :  2d.  This  morbid  production  is  observed  but  very  exceptionally  among  the 
indigenous  population  :  3d.  Europeans  who  do  not  bring  the  germ  of  the  disease  to 
Algiers,  almost  never  become  phthisical :  4th.  Those  who  do  bring  not  only  a  predis- 
position, but  actually  crude  tubercle,  in  greater  or  less  quantity,  in  the  lung,  are  often 
cured  ;  or,  in  the  worst  cases,  the  progress  is  extremely  slow  :  5th.  When  the  tubercle 
has  softened,  the  climate  is  no  longer  favorable,  but  the  reverse. 

The  climate  is  also  beneficial  in  laryngeal  and  bronchial  affections  ;  in  chronic  heart 
disease;  in  gout  and  rheumatism;  and  in  renal  disorders. — Nervous  complaints, 
paralysis,  epilepsy,  and  convulsions  are  aggravated  by  it.  Cerebral  congestions,  and 
a  plethoric  condition  of  the  uterine  organs,  appear  to  be  common  in  Algiers, 


452.    The  Azores — Madeira — Canaries. 

a.  The  Azokes  ok  Western  Isles. — This  group  of  nine  islands  belonging  to  Por- 
tugal, lies  in  the  midst  of  the  Atlantic  Ocean.  They  are  of  volcanic  origin,  all  pos- 
sess similar  features,  and  have  mild  equable  climates.  The  atmosphere  is  saturated 
with  moisture.  A  winter  trip  to  the  Azores  may  be  recommended  where  a  soothing 
relaxing  climate  is  needed.  Hence  it  is  beneficial  in  inflammatory  dyspepsia,  bron- 
chial irritation  with  scanty  secretion,  and  in  the  premonitory  stage  of  consumption. 
Sir  James  Clark  thinks  that  a  change  from  the  Azores  to  Madeira,  and  from  thence 
to  Tenerift'e,  would  in  many  cases  jirove  more  beneficial  than  a  residence  during  the 
whole  winter  in  any  one  of  these  islands. 

,fi.  Madeira. — Of  the  group  of  Madeira  Isles,  the  largest  and  most  important  is 
Madeira,  about  P20  miles  in  circumfer(mce.  Funchal,  its  capital,  has  long  enjoyed 
great  reputation  as  a  winter  residence  for  the  phthisical.     The  invalid  who  leaves  this 


CLIMATES   FOR    INVALIDS.  377 

country  about  the  middle  of  October,  can  reach  Madeira  in  from  ten  to  fourteen 
days;  where  he  will  find  himself  in  a  tro](ical  climate,  with  an  unclouded  sky,  a 
ij^lowiuf^  sun,  a  deep  blue  sea,  a  luxuriant  and  varied  foliaf^e,  and  beautiful  hills  which 
were  covered  with  tlourishinji;  vineyards  Wince  the  autumn  of  18;')2,  however,  when 
the  vine  disease  suddenly  broken  out,  there  has  been  a  sad  change;  the  plants  still  be- 
\u<^  destroyed  by  the  deadly  fungus. — The  return  voyage  should  be  undertaken  about 
the  beginning  of  June. 

The  climate  of  Madeira  is  mild,  equable,  and  moist.  There  are  occasional  storms 
of  wind  and  rain,  and  tires  are  often  necessary  in  the  mornings  and  evenings.  The 
m(>an  annual  teni|)erature  is  (j4.'.)"  ;  that  for  winter  being  60.0,  spring  G'2.3,  summer 
09.5,  and  autumn  07.3.  The  annual  rainfall  is  29.23  inches  ;  the  days  on  which  there 
is  wet  being  about  70,  when-as  in  London  they  number  178.  The  most  injurious 
wind  is  the  hot  })arching  Icste,  from  the  east-southeast;  which  is  often  charged  with 
a  line  dust,  very  irritating  to  the  air-passages. 

The  invalid  who  cannot  bear  a  dry  irritating,  but  needs  a  mild  and  soft  atmos- 
phere, will  obtain  it  here.  Laryngeal,  bronchial,  and  pulmonary  diseas(!s  are 
soothed;  and  benefit  may  be  derived  by  patients  threatened  with  consumption.  If 
he  wish  to  spend  a  second  winter  in  Madeira  before  returning  home,  a  voyage  may 
taken  to  Teneritfe  in  June,  and  the  stay  prolonged  there  until  the  end  of  October. 

y.  The  Canaky  Islands. — This  group  (Fortunataj  Insulae)  consists  of  seven  prin- 
cipal islands,  and  several  islets.  The  climate  differs  from  that  of  the  foregoing  in 
being  warmer,  drier,  and  less  relaxing.  At  Santa  Cruz,  the  capital  of  Tcnvriffe  (the 
only  island  possessing  good  accommodation  for  the  valetudinarian),  the  mciin  annual 
temperature  is  70.L5'';  that  for  winter  being  64.85,  spring  68.87,  summer  70.68,  and 
autumn  7-1.17. — Orotava  and  Laguna  are  sometimes  preferred  to  Santa  Cruz. 


453.   Cafe  of  Good  Hope — Natal. 

«.  The  Cape  of  Good  Hope. — The  climate  is  mild  and  healthy  but  very  dry.  The 
seasons  are  the  reverse  of  those  in  Europe  ;  December  and  January  being  the  warm- 
est, while  June  and  July  are  the  coldest  months.  The  mean  temperature  for  the 
winter  months  of  1858,  at  Cape  Town,  was  57"  F.  The  prevalent  diseases  appear  to 
be  rheumatism  and  dysentery.  Invalids  from  India  are  often  benetited  by  spend- 
ing a  season  at  the  Cape  or  at  Natal. 

&.  Natal. — This  British  Colony  lies  on  the  southeastern  border  of  Africa,  about 
800  miles  from  the  Cape  of  Good  Hope.  There  may  be  said  to  be  only  two  seasons  : 
the  summer  from  October  to  March,  and  the  winter  from  the  beginning  of  April  to 
the  end  of  September  ;  even  in  the  latter,  during  the  coldest  months  of  1858,  the  tem- 
perature was  occasionally  78"  F.  in  the  neigborhood  of  Maritzburg ;  while  in  the 
hottest  months  it  was  occasionally  below  60".  [The  Colony  of  NutaL.  By  Robert  J. 
Mann,  M.D  ,  p.  48.  London,  1860.)  Notwithstanding  its  almost  tropical  ))osition, 
and  the  frecpient  vicissitudes  of  temperature.  Natal  is  very  healthy.  I)r.  j\Iann  re- 
marks, that  while  480  soldiers  die  yearly  out  of  every  1000  stationed  at  Sierra  Leone, 
121  in  1000  at  Jamaica,  78  in  the  West  Indies  generally,  48  in  1000  in  the  Madras 
Presidency,  28  in  1000  at  Bermuda,  27  in  1000  in  the  Mauritius, 25  in  1000  at  St.  He- 
lena, 21  in  1000  at  Gibraltar,  16  in  1000  in  Malta  and  Canada,  and  14  in  every  1000 
in  Nova  Scotia  and  New  Brunswick, — -only  13  in  1000  die  yearly  in  the  western  dis- 
tricts of  the  Ca])e  Colony,  and  only  9  in  1000  in  the  eastern  district.  During  the 
Kafir  war  in  1835,  not  a  single  officer  or  man  was  invalided  during  the  five  months 
of  active  service.  Newly-arrived  settlers  in  Natal,  remain  for  months  under  can- 
vas, without  the  slightest  injury. 


454.   Canada — New  Brunsioich — Nova  Scotia — Newfoundland. 

«.- Canada. — The  British  colony  of  North  America  is  divided  by  the  Ottawa  Kiver 
into  the  provinces  of  Upper  or  West  Canada  (chief  city,  Toronto),  and  Lower  or 
East  Canada  (chief  city,  Quebec).  The  clinuxte  is  marked  by  extri'mes,  the  winters 
being  excessively  cold,  while  the  summers  are  just  as  hot.  The  coldness  of  the  win- 
ter is  mitigated,  however,  by  the  dryness  of  the  air  and  the  absence  of  high  winds  ; 


378  APPENDIX    OF   FORMULA. 

while  the  way  in  which  the  Canadian  protects  himself  with  thick  furs,  and  his  house 
by  well-managed  stoves,  enables  him  to  set  the  frost  at  defiance.  A  gentleman,  res- 
ident in  Canada  for  six  years,  told  the  author  that  with  the  thermometer  — 20*^  he 
never  felt  the  cold  so  raw  and  unpleasant,  as  in  London  at  the  beginning  of  January 
1864. — The  climate  is  also  much  milder  in  Upper  than  Lower  Canada;  but  that  of 
both  provinces  is  healthy  and  conducive  to  longevity. 

j8.  New  Brunswick. — The  climate  of  this  portion  of  British  North  America  re- 
sembles that  of  Canada  ;  the  winters  being  very  severe,  and  the  summers  excessively 
hot.  The  winter,  however,  is  mitigated  by  the  length  and  fineness  of  the  autumn, — 
the  "Indian  summer." 

y.  Nova  Scotia. — This  peninsula  of  North  America,  forming  part  of  the  British 
colonial  territory,  is  separated  from  New  Brunswick  by  an  isthmus  14  miles  across. 
The  climate  is  remarkable  for  vicissitudes  of  temperature,  prolonged  falls  of  rain, 
and  occasional  fogs.  The  inhabitants,  nevertheless,  are  said  to  enjoy  a  remarkable 
degree  of  health. 

(A  Newfotijcdlanb. — This  island,  lying  oiT  the  coast  of  Labrador,  is  separated 
from  the  mainland  by  the  Strait  of  Belleisle,  12  miles  across.  The  surface  is  mostly 
marshy,  and  the  soil  unfavorable  to  cultivation.  The  winters  are  less  severe  than  in 
LTpper  Canada,  but  the  summers  shorter.  Dense  fogs  prevail  along  its  banks,  some- 
times for  the  greater  part  of  the  summer.  The  annual  mortality,  however,  scarcely 
exceeds  12  per  1000  of  the  population,  so  that  the  climate  must  be  favorable  to  the 
constitution. 


455.    West  Indian  Islands. 

Invalids  should  not  be  sent  to  any  of  these  islands  ;  for  though  they  are  not  as  un- 
healthy as  was  formerly  supposed,  yet  severe  fevers  and  inflammatory  diseases  are 
common  and  run  a  rapid  course.  Moreover,  the  returns  show  that  nearly  twice  as 
many  cases  of  consumption  originate  among  oiir  troops  stationed  here,  as  at  home. 
If  a  man  in  search  of  health  will  visit  them,  however,  he  must  only  do  so  between 
the  months  of  December  and  April,  after  the  heavy  autumnal  rains.  Jamaica,  the 
chief  of  the  British  possessions,  is  reputed  the  most  healthy.  The  Bahamas  are  re- 
sorted to  by  American  invalids.  In  the  Bermudas  and  the  Barbadoes,  dysentery, 
rheumatism,  and  yellow  fever  are  the  prevailing  diseases. 


456.  mil  and  Marine  Sanitaria  in  India. 

The  Indian  hill  staiions  oflTer  a  climate  which  is  of  great  use  to  convalescents  from 
fever,  invalids  from  local  cachexia,  &c. ;  and  which  exerts  a  powerful  influence  in 
maintaining  the  health  and  vigor  of  Europeans. 

According  to  Dr.  W.  J.  Moore,  of  the  Bombay  Medical  Service,  the  climate  of 
hill  ranges  differs  from  that  of  the  plains  in  having  a  mean  temperature  some  10°  to 
15°  cooler,  in  being  above  the  influence  of  the  hot  winds,  and  in  being  more  humid 
during  the  monsoon  season.  Various  localities  ditfer  in  minor  points  :  in  the  Hima- 
Inyas,  a  greater  elevation  will  procure  a  colder  climate  ;  the  fall  of  rain  has  sometimes 
been  excessive  at  Mahahleshwar,  at  Nynee  Tal,  &c.,  while  at  many  of  the  hill  stations 
sanitary  laws  are  still  too  much  disregarded,  and  too  little  care  is  "taken  to  protect  the 
system  from  the  inclemencies  of  the  weather. 

The  climate  of  the  hill  stations  in  the  Himalm/as,  of  Mount  Aboo,  of  Ootocamund, 
JBonqa.lo7-e,  &c.,  &c.,  as  well  as  of  Mathcran  and  Mahableshwar'  in  Bombay,  is  of  great 
service  to  the  European  whose  health  has  deteriorated  from  a  residence  on  the  Indian 
plains.  The  air  invigorates  both  mind  and  body.  But  it  is  unsuitable  whete  there 
is  structural  disease  of  any  internal  organ  ;  diarrlux-a  and  dysentery  being  increased 
by  it,  while  aflections  of  the  brain  and  lungs  and  liver  are  niueh  aggravated. 
Cholera,  dysentery,  and  malarious  fevers  are  less  prevalent  and  fatal  in  the  hill  sta- 
tions, than  in  the  plains  below.  Yet  these  atfections  are  met  with  at  high  elevations; 
as  are  also  cases  of  hepatitis,  tuberculosis,  typhus,  croup,  diphtheria,  snnill-pox,  rheu- 
matism, neuralgia,  severe  catarrh,  and  hill-diarrhcea.— It  has  been  well  suggested  that 
European  troops  should  be  located  more  on  the  hills,  and  less  on  the  phuns  than  is 
now  the  case ;  not  waiting  until  they  are  weakened  by  disease,  climate,  and  service 
to  be  sent  to  these  more  temperate  and  less  malarious  regions. 


CLIMATES   FOR    INVALIDS.  379 

Many  of  tho  disoasos  winch  aro  a,c;c:rav,atocl  by  tho  hill  stations  of  India,  arf  much 
benetited  by  the  greater  purity  and  uniformity  of  the  sea  climates.  The  invalid  who 
has  been  prostrated  by  the  harsh  parc-hins?  winds  of  the  interior,  not  only  has  his 
bodily  sutlerin<;;s  greatly  ameliorated  by  the  moist  fresh  breeze  from  the  sea,  but  the 
mi're  siglit  of  tile  ocean  raises  his  powers  by  giving  him  hope  and  contidence.  It  is 
necessary  to  select  an  open  spot,  with  high  clitfs  and  a  rocky  sliore  ;  low,  flat,  sandy 
coasts  being  generally  unhealthy  in  the  tropics.  The  proximity  of  the  island  of  Mur- 
lahnn  to  Madras  and  Calcutta,  as  well  as  its  geological  characteristics,  have  led  Dr. 
Macjihcrson  to  recommend  it  as  a  marine  sanitarium. 

The  weak-chested,  and  those  persons  of  a  strumous  habit  predisposed  to  phthisis,  are 
often  greatly  benefited  by  a  residence  in  India  ;  but  where  tubercle  is  deposited  in  the 
lungs,  the  climate  seems  to  accelerate  the  progress  of  the  disease.  Individuals  of  a 
phlegmatic  temperament  with  difficulty  in  digesting,  and  a  languid  circulation,  often 
improve  very  much  in  this  country. 


457.  Australia — Tasmania — N'ew  Zealand. 

a..  Australia. — The  immense  extent  of  territory  known  as  Australia,  in  the  South 
Pacific  Ocean,  possesses  a  temperate  climate,  which  appears  very  favorable  to  the 
Euro])ean  constitution.  In  speaking  of  this  antipodal  region  it  is  necessary  to  re- 
member that  the  meteorological  ]ihenoniena.are  generally  the  reverse  of  those  ex]ie- 
rienced  in  this  country ;  the  months  of  December,  January,  and  February  corres- 
ponding to  our  summer,  and  having  a  mean  temperature  of  about  80°,  while  those  of 
June,  July,  and  August  constitute  the  winter,  the  thermometer  marking  on  an  aver- 
age 40°  in  an  exposed  situation. 

In  May,  1836,  the  number  of  settlers  in  the  district  of  Victoria  (formerly  Port  Philip) 
was  177.  At  the  end  of  a  quarter  of  acentury  (April,  1861),  the  amount  had  increased 
to  540,322.  The  total  area  of  Victoria  (86,831  miles)  is  nearly  as  large  as  that  of 
England,  Scotland,  and  Wales  united.  Melbourne,  the  capital  of  Victoria,  is  the 
most  prosperous  commercial  city  of  the  southern  world.  The  mean  annual  tempera- 
ture is  57° ;  extreme  cold  in  winter,  and  excessive  heat  in  summer  (except  nine  or 
ten  times  in  the  season,  under  the  influence  of  hot  winds),  being  unknown.  Although 
the  annual  rainfall  is  26  inches  (that  for  London  being  21.6),  yet  the  average  number 
of  wet  days  is  much  less  than  in  Great  Britain  ;  for  in  Melbourne  the  rain  falls  with 
great  violence,  but  it  only  lasts  a  few  hours,  and  then  the  sky  clears.  A  continuance 
of  cloudy  weather  is  unknown.  There  is  a  genial  sun  ;  with  a  pure,  dry,  stimulating 
air. 

Dr.  S.  Dougan  Bird  says  (Australasian  Climates,  and  theb-  hvfluence  in  Pulmonary 
Consumption,  p.  41,  London,  1863),  that  the  main  characteristics  of  the  Victorian 
climate  are  these  :  "  It  is  a  temperate  warm  climate,  whose  average  summer  heat  is  but 
two  or  three  degrees  above  that  of  London  ;  while  in  winter  it  is  warmer  than  Nice  or 
Naples,  and  as  warm  as  Valencia  or  Barcelona  ;  and  actual  cold  is  never  felt  at,  or 
near,  the  sea  level.  The  air  is  generally  dry,  always  stimulating  and  ozoniferous  ;  but 
so  tempered  by  the  prevalence  of  ocean  winds,  that  it  is  prevented  from  becoming  irri- 
tating, like  that  of  Nice  or  Provence.  With  this  there  is  a  very  large  proportion  of 
sunny  cheerful  weather  during  the  whole  year.  In  no  climate  with  which  I  am  ac- 
quainted is  there  so  much  pleasant  weather  during  the  year  as  in  Victoria — so  many 
unclouded  days,  when  it  is  neither  too  hot  nor  too  cold — and  an  invalid  has,  conse- 
quently, every  temptation  to  be  in  the  open  air." 

Tuberculosis  (i.  e.,  scrofula,  phthisis,  tabes  mesenterica,  and  tubercular  meningitis) 
is  rare  in  Victoria,  the  mortality  not  being  one-fourth  of  that  in  Great  Britain  from 
the  same  cause.  Yet  the  population  is  composed  of  those  who,  hereditarily,  from  oc- 
cupation, and  mode  of  living  (except  that  animal  food  is  much  cheaper)  are  as  much 
predisposed  to  consumption,  as  the  inhabitants  of  London  or  Liverpool. 

In  the  penal  establishments  o{  Pentridc/e  and  Col  I  ingivood  (the  iormev  &vo,  the  latter 
two  miles  from  Melbourne),  with  an  average  of  1000  male  adult  prisoners,  the  greater 
number  undergoing  long  sentences,  there  was  no  death  from  consumption  in  1860  or 
1861.  Comparing  this  with  the  statistics  to  be  found  in  the  Reports  of  the  Directors  of 
Convict  Prisons  in  England,  it  appears  that  at  Millbank,  the  greatest  number  of  male 
])risoners  in  confinement,  at  any  one  time  during  1860  was  741,  the  daily  average 
throughout  the  year  being  531,  and  the  total  number  in  the  year  2404.  Of  these  2 
were  recommended  for  pardon  on  account  of  advanced  consumption  ;  2  died  from  the 
same  ;  and  102  were  removed  to  the  Invalid  prisons  of  Dartmoor,  Lewes,  or  Woldng, 


380  APPENDIX   OF    FORMULA. 

on  account  of  phthisis.  These  nnmbfr?,  moreover,  do  not  include  16  who  were  removed 
for  ha-moptysis. — At  the  same  prison  in  1861,  the  greatest  number  of  such  prisoners  in 
confinement  at  one  time  was  8(J9,  the  daily  average  throughout  the  year  615,  and  the 
total  number  in  the  year  2612.  Of  these  .5  died  from  phthisis,  and  132  were  removed 
to  Invalid  prisons  on  account  of  it.  This  number  also  does  not  include  19  removed  for 
hffimoptysis. 

At  Si/dney  (the  capital  of  New  South  Wales,  East  Australia)  the  mean  annual  tem- 
perature is  about  6.5°.  Heavy  rains  fall  between  June  and  September.  Disease  is 
said  to  assume  a  milder  form  here  than  in  European  countries.  Dysentery  and  pul- 
monary affections  are,  however,  not  uncommon.  The  winters  are  colder  than  at 
Moreton  Bay,  though  this  season  is  very  salubrious  and  agreeable. 

Moreion  Bay  (Queensland,  East  Australia),  has  a  fine  winter  climate,  which  proves 
very  useful  in  advanced  cases  of  phthisis,  with  irritability  of  the  system  and  a  tendency 
to  bronchial  inflammation.  The  average  temperature  on  the  coast,  during  the  cold 
months,  is  62°  or  63;  the  air  being  soft  and  sedative,  and  the  weather  brilliant  and 
sunny.     A  few  miles  inland  the  ground  rises,  and  the  air  is  more  dry  and  bracing. 

In  cases  of  consumption  with  copious  expectoration,  and  in  the  chronic  bronchitis 
of  old  people,  Adelaide,  the  chief  city  of  South  Australia,  may  be  chosen  as  a  resi- 
dence.    The  air  is  dry,  warm,  and  tonic;  the  winter  temperature  averaging  53°. 

The  invalid  leaving  England  for  Australia,  will  generally  find  the  long  uninter- 
rupted voyage  round  the  Cape  of  Good  Hope,  in  a  comfortable  ship,  much  to  be  pre- 
ferred to  the  more  exciting  and  fatiguing  "overland  route,"  by  way  of  Suez  and 
Galle.  The  best  time  for  leaving  this  country  is  from  the  middle  of  October  to  the 
end  of  November;  when  the  new  home  will  be  reached  in  about  ninety  days  from 
Liverpool.  Thus  supposing  him  to  arrive  about  the  end  of  January  he  will  find  a 
pale-blue  cloudless  sky,  and  the  thermometer  at  90°  in  the  middle  of  the  day  without 
any  unpleasant  sense  of  heat.  With  a  feeling  of  new  life,  general  exhilaration,  and 
a  good  appetite,  he  will  experience  a  desire  to  be  at  work.  The  difBculty  seems  to  be 
to  persuade  the  phthisical  that  they  are  not  cured ;  and  that  the  general  rules  of  hy- 
giene must  be  adopted,  and  all  excesses  avoided  to  prevent  the  pulmonary  mischief 
again  starting  into  activitj-,  or  to  escape  hepatic  congestion,  or  that  he  may  obtain 
and  retain  health  and  vigor. 

0.  Tasmania. — This  island  (known  as  Yan  Diemen's  Land,  until  the  abandonment 
of  transportation  in  1852)  is  sepai'ated  from  the  southernnn)st  point  of  Australia  by 
Bass's  Strait.  The  chief  towns  are  Hobart  Town  in  the  south,  and  Launceston  in  the 
north;  the  climate  of  both  being  salubrious  and  delightful,  and  highly  conducive  to 
longevity.  The  latter  jiort  is  reached  in  twenty-four  hours,  by  steamer  from  Mel- 
bourne, and  is  beneficial  to  such  cases  as  are  usually  sent  to  Pau.  The  air  is  moist, 
sedative,  and  equable.  In  the  winter  months  of  June,  July,  and  August,  there  is 
never  great  cold  during  the  day.  The  mean  annual  temperature  of  Hobart  Town  is 
52°.     Tasmania  is  described  as  "  the  Garden  of  Australia." 

y.  New  Zealand. — This  group  in  the  South  Pacific  Ocean,  consists  of  two  princi- 
pal (the  North  and  Middle)  and  several  smaller  islands.  The  chief  British  settlements 
are  Aitcklnnd,  Neiv  Plyniouih  or  Tarmiki,  Haivkes  Bay,  and  H'elluigion,  in  the  North 
Island;  with  AV.son,  Marlborfnigh ,  Cnnterbury,  and  Ofayo,  in  the  Middle  Island.  The 
temperature  of  New  Zealand  is  marked  by  its  uniformitj'.  The  mean  of  the  warmest 
month  at  Auckland  is  68°,  and  of  the  coldest  at  Otago  42°.  The  climate,  which  in 
general  terms  may  be  described  as  mild  and  soft,  appears  to  be  favorable  to  the  Eu- 
ropean constitution. 


XX.  MINERAL  WATERS. 

458.   General  Observations. 

Mineral  waters  have  been  used  in  medical  practice  since  the  days  when  /Esculapiua 
was  worshipped  throughout  Greece,  and  when  his  temples  were  erected  in  healthy 
places,  near  wells  which  were  believed  to  have  healing  powers.  Like  many  other 
important  remedies  their  virtues  have  been  regarded  with  singular  skepticismat  one 
time,  and  with  blind  credulity  at  another.  The  practitioner  in  the  present  day  wisely 
attempts  to  keep  the  iniddle  course  ;  neither  over-estimating,  nor  unduly  depreciating, 
the  value  of  these  agents  in  subduing  diseases. 

A  mineral  water  is  merely  a  complicated  medicine,  containing  various  salts  and 
gases  blended  together.  The  ingredients  are  generally  derived  from  the  soil  or  rocks 
through  which  the  waters  pass;  and  they  consist  of  saline  principles,  organic  and 


MINERAL   WATERS.  381 

inori^iuiic^  niattors,  and  more  or  less  of  a  free  gas  (sulphiirottod  hydrogen,  carljonic 
acid,  nitrogen,  or  oxygen).  The  cause  of  the  temperature  of  hot  springs  is  a  niys- 
tery ;  and  piiiiosophers  know  not  whcHiier  it  is  due  to  the  internal  heat  of  the  globe, 
to  electricity,  to  ciiemieal  decomposition,  or  to  volcanic  agency.  The  heat  is  always 
under  that  of  boiling  water  (212°  F.),  and  it  has  varied  but  little  during  a  long  suc- 
cession of  years. — The  waters  are  administered  internally  and  applied  externally;  and 
they  act  chieHy  by  purifying  the  blood,  increasing  the  processes  of  secretion  and 
excretion,  iind  by  stimulating  the  cutaneous  and  visceral  circulation.  It  cannot  be 
doubted  that  these  etl'eets  ai'(!  due  to  tl)e  ehemiciil  (•ompii>iti<)n  and  tem])erature  of  the 
waters  ;  though  it  is  allowed  on  all  hands  that  the  bent'ticial  influence  is  aided  l>y  the 
locality  of  the  spring,  the  nature  of  the  climate,  the  absence  of  business  and  care,  the 
diet,  and  the  general  regimen. 

Mineral  waters  are  useful  only  in  chronic  disorders,  where  there  is  but  little,  if  any, 
structural  change  ;  or  in  cases  where  disease  is  threatened.  Hence  the  sutferers  sent 
to  the  Spas  are  for  the  most  part  affected  with  skin  affections,  rebellious  ulcers,  stiff- 
ness of  limbs  from  old  sprains,  etc.  ;  chronic  gout,  riieumatism,  sciatica,  or  neuralgia; 
hepatic  or  renal  disorders  ;  ))aralytic  affections,  where  all  active  disease  has  b(fen  sub- 
dued ;  hysteria  or  hypochondriasis;  or  with  cei'tain  functional  disorders  of  the  uterine 
system.  Nothing  but  mischief  can  arise  where  there  is  either  acute  disease,  tuber- 
culosis, cancer,  aneurism,  or  mischief  about  the  heart.  The  young  and  the  very  aged, 
moreover,  will  derive  little  or  no  benefit:  and  in  pregnancy  the  use  of  the  sj)rings,  to 
say  the  least,  demands  great  caution. 

The  time  for  residing  at  some  of  the  Spas  is  from  May  to  September  ;  but  at  several 
of  the  foreign  ones  it  is  only  from  June  until  the  end  of  August.  At  a  few  of  the  hot 
springs,  invalids  (chiefly  the  gouty)  remain  through  the  winter.  The  treatment, 
however,  is  not  commonly  to  be  prolonged  beyond  six  or  eight  weeks  ;  and  often  three 
or  four  will  suffice.  The  invalid  should  not  l)e  led  to  expect  immediate  relief.  And 
he  should  be  cautioned  against  the  popular  idea  that  the  benefit  derived  will  be  in 
prop(jrtion  to  the  quantity  of  water  taken  ;  while  it  may  be  as  well  to  let  him  know 
that  "critical  eruptions"  (psydracia  thermalis),  and  "critical  fluxes"  are  neither 
necessary  nor  advantageous.  As  a  rule,  bathing  and  drinking  ought  not  to  be  com- 
menced on  the  same  day ;  and  at  first  only  a  moderate  quantity  of  the  water  should 
be  taken.  Very  hot  water  is  also  to  be  cooled,  and  very  cold  to  be  warmed,  before 
drinking. 

When  the  strength  will  permit  of  it,  early  rising  (at  about  6  o'clock)  is  to  be  recom- 
mended, so  that  the  doses  may  be  taken  before  breakfast.  The  contents  of  the  tumbler 
are  to  be  sipped  slowly  and  methodically,  not  hastily  swallowed  like  a  nauseous 
draught;  and  an  interval  of  fifteen  minutes,  at  least,  should  be  allowed  between  each 
glass,  which  time  may  well  be  spent  in  a  short  walk.  An  hour  after  the  last  glass,  a 
light  breakfast  is  to  be  taken.  Then,  a  gentle  saunter,  the  bath,  reading,  writing  let- 
ters, &c.,  will  agreeably  occupy  the  hours  till  the  early  dinner;  at  which  fruit  and 
raw  vegetables  iiad  better  be  avoided,  while  a  moderate  quantity  of  light  wine,  or  of 
mild  bitter  beer  may  be  allowed.  An  excursion  to  the  objects  of  interest  in  the  neigh- 
borhood, j)erhaps  one  or  two  more  glasses  of  water — never  more  than  half  tlie  quantity 
taken  in  the  morning, — a  light  supper  at  8  o'clock,  and  bed  two  hours  afterwards,  will 
complete  the  day's  work. 

Mineral  waters  are  sometimes  classified  into  the  thermal  or  hot,  and  the  cold 
springs.  But  a  more  useful  division  is  into  chalybeate,  sulphurous,  gaseous  or  acid- 
ulous, saline,  iodo-bromated,  and  muriated  lithia  waters. 

Class  1.  Chalybeate  or  Feri'ijginous  Waters. — A  large  number  of  waters  contain 
small  quantities  of  iron,  but  none  are  considered  as  belonging  to  this  class  unless  the 
proportion  of  metal  is  considerable.  The  chief  acidulous  chalybeates  (those  which 
contain  much  carbonic  acid  gas)  are  the  waters  of  Schwalbach,  S]»a,  Pyrmont,  Briick- 
enau,  the  Cambray  well  at  Cheltenham,  and  Tunbridge  Wells.  The  princi]ial  saline 
acidulous  chalybeates  (such  as,  in  addition  to  iron  and  carbonic  acid,  have  a  certain 
amount  of  sulphate  and  carbonate  of  soda,  with  chloride  of  sodium)  are  the  springs 
of  Franzensbad,  Bocklet,  Harrogate,  &c. — Chalybeate  waters  are  useful  in  anaemia, 
and  in  functional  disorders  of  the  generative  organs. 

Class  2.  Sulphurous  Waters. — They  have  the  odor  of  rotten  eggs,  owing  to  their 
impregnation  with  sulj)hiiretted  hydrogen.  The  chief  sulphurous  thermals  are  those 
of  Aix-la-Chapelle,  Baden  near  Vienna,  Aix-les-Bains,  Bareges,  Bagndres  de  Lu- 
chon,  St.  Sauveur,  Cauterets,  Eaux-Bonnes,  and  Eaux-Chaudes.  Amongst  the  cold 
sulphurous  springs  may  be  mentioned  Harrogate  and  Booklet. — Sulphurous  waters 
are  recommended  in  cutaneous,  hepatic,  uterine,  rheumatic,  gouty,  and  old  constitu- 
tional syphilitic  diseases.  In  chronic  poisoning  by  mercury,  lead,  or  copper,  they 
help  to  eliminate  the  injurious  minerals. 

Class  3.  Gaseous  or  Acidulous  Waters. — The  carbonic  acid  gas  gives  these  waters  a 
sharp  acidulous  taste,  with  a  sparkling  appearance.     The  most  important  are  the 


382  APPENDIX    OF    FORMULA. 

thermsil  ?priii2:s  of  Yichy,  and  the  cold  of  Fachingen  and  Bilin.  The  refreshing 
and  I'xhihirating  waters  of  this  class  are  recommended  in  dyspepsia,  hepatic  derange- 
ment, gout  and  rheumatism,  &g. 

Class  4:.  Saline  \Vate7-s. — Those  which  are  purgative  and  have  sulphate  of  soda  or 
sulphate  of  magnesia  as  their  chief  ingredients,  are  Epsom,  Cheltenham,  Leaming- 
ton, Seidlitz,  Polna,  Carlsbad,  and  Marienhad.  Those  which  have  chloride  of  so- 
dium as  their  characteristic  ingredient,  are  Wiesbaden,  Baden-Baden,  Homburg, 
Kissingen,  &c.  The  sulphate  or  carbonate  of  lime,  or  both,  predominate  in  the  ther- 
mal waters  of  Bath  and  Buxton ;  while  the  carbonate  or  bicarbonate  of  soda  is  the 
characteristic  ingredient  of  the  thermal  springs  at  Ems,  Teplitz,  &c. 

Class  5.  lodo-bromaied  Waters. — The  springs  at  Krcuznach  are  the  most  celebrated 
of  this  class;  while  in  England  theje  is  the  Woodhall  spa.  The  waters  are  used  in 
all  forms  of  scrofula,  in  many  chronic  skin  diseases,  in  uterine  tumors,  and  in  old- 
standing  constitutional  syphilis. 

Class  6.  Muriaied  Liihia  Wate7-s. — The  springs  of  Baden-Baden  have  considerable 
reputation  for  the  cure  of  gout  and  the  uric  acid  diathesis,  owing  to  the  chloride  of 
lithium  which  they  contain. 

459.   Tunhridge  Wells,  in  Kent  and  Sussex. 

This  town  is  more  visited  on  account  of  its  dry  bracing  air,  beautiful  varied 
scenery,  and  fine  walks,  than  for  its  chalybeate  Spa.  The  water  of  the  latter  has  a 
temperature  of  50°,  is  feebly  ferruginous  to  the  taste,  contains  about  a  quarter  of  a 
grain  of  oxide  of  iron  to  the  pint,  and  has  just  sufficient  carbonic  acid  to  hold  the 
metal  in  solution.  Frequently,  increased  doses  of  steel  are  given  with  the  water;  or 
sulphate  of  magnesia  may  be  added,  if  an  aperient  be  needed.  The  chief  value  of 
the  spring  is  witnessed  in  cases  of  an:emia  and  chlorosis,  debility  inducing  dyspepsia, 
and  in  general  lassitude  from  a  too  sedentary  mode  of  life. 

460.  Bath,  in  Somersetshire. 

The  thermal  mineral  springs,  situated  in  the  southern  part  of  the  town,  near  the 
Abbev  church,  are  four  in  number.  The  temperature  of  the  waters  varies  from  120'* 
F.  to  104"  F.  Speaking  generally,  the  solid  contents  are  about  ten  grains  to  the 
pint.  The  chief  constituents  are  sulphate  of  lime,  sulphate  of  soda,  chloride  of  sodium, 
chloride  of  magnesium,  carbonateof  lime,  silicic  acid,  and  a  comparatively  small  portion 
of  iron.  The  gases  evolved  consist  of  nitrogen  in  large  quantity,  with  oxygen  and 
carbonic  acid. 

The  sparkling  appearance  of  the  waters  at  the  springs,  is  due  to  the  carbonic  acid 
they  contain.  The  quantity  generally  drank  is  from  one-quarter  to  one  pint,  before 
breakfast  and  again  in  the  afternoon.  Taken  quietlj'  and  leisurely,  the  etfect  is  usu- 
ally to  raise  the  temperature  of  the  body,  to  quicken  the  circulation,  to  increase  the 
appetite,  and  to  promote  the  salivarj-  and  renal  secretions.  When  headache,  loss  of 
appetite,  thirst,  nausea,  mental  depression,  and  a  diminished  llow  of  urine  follow 
their  use,  they  should  either  be  discontinued  or  taken  in  very  small  doses. 

The  accommodation  for  bathing  is  excellent;  there  being  good  douche,  shower, 
vapor,  reclining,  swimming,  and  chair  baths.  By  the  latter,  worked  with  a  crane,  a 
helpless  invalid  is  lowered  into,  and  raised  from,  the  water.  The  bath  is  to  be  taken 
three  or  four  times  a  week,  not  too  near  the  meal-times,  and  the  patient  should  re- 
main in  it  from  ten  to  thirty  minutes.     The  proper  temperature  is  96"  to  98''  F. 

The  spring  and  autumn  are  the  best  seasons  for  taking  the  baths  and  waters,  though 
they  may  be  advantageously  employed  in  the  winter.  And  the  diseases  which  are 
most  benefited  by  them  are  subacute  gout,  chronic  rheumatism,  sciatica,  neuralgia, 
lumbago,  rheumatoid  arthritis,  contracted  or  rigid  joints,  dyspepsia,  paralysis  from 
rheumatism  or  inetallic  poisoning,  leucorrhoea,  chorea,  anaemia,  lepra,  eczema,  and 
psoriasis. 

461.   Cheltenham,  in  Gloucestershire. 

Since  the  cure  of  George  the  Third  by  the  waters  of  the  Koyal  Old  Wells,  the  Spa 
has  been  a  fashionable  resort.  Situated  8  miles  E.N.E.  of  Gloucester,  Cheltenham 
offers  an  agreeable  permanent  residence,  particularly  for  valetudinarians  from  the 
East  or  West  Indies.  The  climate  in  winter  is  mild  and  equable,  rather  moist,  and 
sheltered  by  the  Cotswold  and  other  hills  from  the  north  and  east  winds.  The  sea- 
son, however,  is  from  the  middle  of  April  to  the  beginning  of  October. 

The  waters  are  chiefly  taken  internally.  There  are  several  cold  springs,  all  of 
them  powerfully  saline  except  the  Cambray  chalybeate.  The  waters  of  the  Koyal 
Old  Wells  contain  chiefly  chloride  of  sodium,  chloride  of  calciu7n,  chloride  of  tnag- 


MINERAL   WATERS.  383 

nesbnn,  and  su/pkafe  of  snrla.  Thoy  are  but  slio;htly  c^aseous.  Some  of  the  wells  of 
the  MoNTl'KLLlER  Sl'A  hjivo,  in  addition  to  the  fore^iMnc,  a  little  oxide  of  iron,  and 
iodtc7-etted  itKH/nesian  saline  salts.  There  is  an  unusual  amount  of  siUm  in  the  Pitt- 
viLLE  saline;  while  the  Camiiray  spring  is  sirong\y  c/mlyheate.  The  3Iont](ellier 
baths  have  accommodation  for  warm  and  cold  bathing,  swimming,  medicated  air  and 
vajior  douches,  «S:c. 

These  springs  enjoy  considerable  reputation  for  relieving  the  diseases  engendered 
by  a  residence  in  tropical  climates,  and  hence  many  old  Indians  with  liver  atl'ections 
resort  to  them.  They  are  also  useful  m  gouty  and  rheumatic  disorders,  in  the  lithic 
acid  diathesis,  in  plethoric  and  irritable  systems,  in  skin  diseases,  in  dyspepsia  with 
torpidity  of  the  bowels,  as  well  as  in  some  forms  of  amenorrhcea  and  chlorosis.  The 
dose  is  usually  from  half  a  pint  to  one  pint  before  breakfast;  it  is  better  to  take  the 
water  pure,  without  the  addition  of  any  "solution"  of  the  crystallized  salts;  and  it 
may  be  warmed  if  a  more  than  ordinary  aperient  effect  is  needed.  The  sj)ring  to  be 
recommend(!d  must  depend  upon  whether  a  simply  alterative,  or  an  alterative  and 
tonic  remedy  is  indicated. 

462.  Purton  and  Melksham,  in  Wiltshire. 

The  healthy  village  of  Purton  in  North  Wilts,  4J  miles  W.N.W.  of  Swindon,  has 
a  dry  bracing  air.  The  Spa  is  2^  miles  from  the  village,  in  a  field  known  as  Salt's 
Hole,  where  a  pump-room  has  recently  (18-39)  been  erected  for  the  accommodation  of 
visitors.  An  analysis  of  the  water  shows  that  it  is  rich  in  sulphate  of  soda,  sutji/iate  of 
magnesia,  sulphate  of  lime,  carbonate  of  potash,  and  chloride  of  sodium.  It  has  also 
small  quantities  of  sulphate  of  potash,  silica,  iodide  of  sodium,  and  bromide  of  mag- 
nesium; with  traces  of  iron,  phosphoric  acid,  and  sulphuretted  hydrogen.  There  is  a 
large  amount  of  free  carbonic  acid  gas;  and  the  temperature  is  58.5U°  F. 

The  Purton  sulphated  and  bromo-iodated  saline  water  may  be  recommended  where 
an  alterative  stimulant  is  needed.  It  seems  to  have  been  useful  in  strumous  sores 
and  enlarged  glands,  threatened  consumption,  stomach  and  liver  disorders,  gouty  and 
rheumatic  affections,  obstinate  skin  diseases,  and  in  functional  derangements  of  the 
uterine  system.  The  dose  is  from  half  a  pint  to  a  pint  before  breakfast,  with  half  a 
pint  in  the  evening. 

The  small  town  of  Melksham  lies  10  miles  E.S.E.  of  Bath,  in  a  fine  open  country. 
In  its  vicinity  are  baths  and  a  pump-room  erected  over  the  chalybeate  and  saline 
springs.  The  chief  constituents  of  the  waters  are  the  salts  of  lime  and  7nag?iesia,  with 
smaller  portions  of  soda  and  iro7i ;  and  they  a»e  artificially  charged  with  gas  for  ex- 
portation. In  strumous,  rheumatic,  and  cutaneous  diseases,  the  medicated  vapor  and 
douche  baths  may  be  employed  simultaneously  with  the  internal  use  of  the  waters. 

463.  Leamington,  in  WarwicJcshire. 

Being  less  protected  by  hills  than  Cheltenham,  the  town  of  Leamington,  2J  miles 
E.  of  Warwick,  has  a  lower  temperature.  The  climate,  however,  is  genial  and  bra- 
cing, but  humid  ;  while  it  is  agreeable  and  healthy  to  the  fiagging  invalid  during  the 
autumn  and  winter  months. 

The  springs  all  lie  near  the  banks  of  the  Leam  ;  their  principal  salts  being, — chlo- 
ride of  sodium,  sulphate  of  soda,  chloride  of  calcium,  and  chloride  of  Tnagncsium.  The 
chief  gas  is  carbonic  acid,  with  great  quantities  of  nitrogen  and  oxygen.  The  most 
ancient  and  most  used  of  the  springs  is  the  Old  W^ell.  The  water  at  Goold's 
Spring  and  Baths  contains  more  chloride  of  sodium,  while  Curtis's  Well  has 
more  muriate  of  mag7iesia  than  the  others.  Tlie  Victoria  Well  and  Pumi'-room, 
possesses  a  weak  mdphurous,  and  a  saline  chalybeate  spring;  and  so  does  Lee's  Well. 

The  temperature  of  the  Leamington  waters  is  about  48°  F. ;  and  their  action  is 
aperient  and  alterative.  They  are  suitable  for  the  same  class  of  cases  as  is  sent  to  the 
Cheltenham  springs ;  but  being  more  active,  they  agree  better  with  invalids  of  a 
torpid  habit,  than  with  those  of  a  susceptible  irritable  temperament. 

464.  Buxton,  in  Derbyshire. 

For  invalids  requiring  mountain  air  Buxton  may  be  recommended.  Situated  31 
miles  W.N.W.  of  Derby,  at  an  elevation  of  900  fee\,  while  some  of  the  neighboring 
hills  are  2000  feet  above  the  sea,  it  enjoys  a  pure  bracing  air.  The  season  is  chiefiy 
from  June  to  October;  the  winds  being  sharp  and  cold  late  in  the  autumn,  during 
winter,  and  early  in  the  spring.  It  is  not  to  be  selected  where  there  is  a  tendency  to 
internal  hemorrhage. 

The  Buxton  waters  issue  abundantly  from  several  crevicea  in  the  limestone  rock, 


384  APPENDIX    OF    FORMULA. 

at  a  temperature  of  82°  F.  Tlie  chief  saline  salts  in  them,  are,  cnrbonate  of  lime,  car- 
bonate of  magnesia,  chloride  of  sodium  and  calcium,  and  potassi.i/.m.,  with  silica,  carbonate 
of  protoxide  of  iron,  and  traces  oi  fiuoride  of  calcium  and  j)hosj)hate  of  lime:  though  so 
small  is  the  quantity,  that  in  the  whole,  they  only  amount  to  18.434  grains  in  the  im- 
perial gallon.  In  the  same  amount  of  water  Dr.  Playfair  found  (1852)  free  carbonic 
acid,  in  weight,  704.2  grains,  nitrogen  gas  206  cuhic  inches,  and  carbonic  acid  gas  15.66 
cubic  inches.  According  to  the  most  recent  analysis  by  Dr.  Sheridan  Muspratt  (1860) 
the  quantity  of  nitrogen  gas,  at  the  moment  of  issue,  is  no  less  than  504  cubic  inches 
per  gallon. — As  these  waters,  minus  their  gases,  have  only  the  composition  of  ordi- 
nary spring  water,  their  stimulating  effects  are  generallj^  attributed  to  the  nitrogen. 
They  are,  however,  chiefly  used  externally  ;  the  accommodation  for  plunge,  swim- 
ming, and  douche  baths  being  excellent.  The  good  which  results  from  the  latter  is 
most  marked  in  cases  of  gout  and  rheumatism,  sprains  and  muscular  contractions, 
and  where  it  is  wished  to  stimulate  the  vascular  or  nervous  or  digestive  systems. 

A  plea.sant  drive  from  Buxton  is  the  picturesque  village  of  Matlock,  built  on  the 
slope  of  a  hill,  at  the  base  of  which  flows  the  Derwent.  It  is  an  agreeable  summer 
residence,  and  its  springs  supply  large  tepid  baths.  The  water,  however,  has  no 
medicinal  properties,  though  the  guide-books  describe  Matlock  as  a  valuable  Spa. 

465.    Woodhall,  in  Lincolnshire. 

This  strong  saline  spring  rises  in  a  plain  3  miles  W.S.W.  of  Horncastle,  and  con- 
tains more  iodine  and  bromine  than  any  other  English  water.  It  has  also  189  grains 
oi  chloride  of  sodium  in  the  pint,  with  a  little  chloride  of  calcium  and  magnesium,  bicar- 
bonate of  soda,  and  sulphate  of  soda.  The  temperature  is  55°.  It  is  chiefly  used  ex- 
ternally in  rheumatic  and  cutaneous  afl'ections,  and  in  scrofula.  Taken  internally, 
half  a  pint  acts  as  a  mild  aperient. 


466.  Harrogate,  in  Yorkshire. 

High  and  Low  Harrogate,  half  a  mile  distant  from  each  other,  and  27  miles  W. 
of  York,  are  tilled  with  visitors  during  the  season, — from  June  until  the  middle  of 
October.  The  air  is  pure  and  bracing,  but  somewhat  humid.  Low  Harrogate  is  the 
most  sheltered. 

There  are  upwards  of  fifty  different  springs,  some  of  which  have  been  in  repute 
since  the  end  of  the  17th  century.  The  waters  are  all  cold,  being  generally  warmed 
artificially  before  they  are  drunk.  Dr.  Kennion  divides  the  springs  into  four  distinct 
groups:  (1)  The  strong  sulphurous  waters.  (2)  The  mild  sulphurous  waters  with 
alkaline  impregnations.  (3)  The  saline  chalybeate  waters.  And  (4)  The  pure  cha- 
lybeate waters. 

1.  Strong  Sulphurous  Springs. — As  types  of  this  class  may  be  mentioned  the  Old 
Sulphur  Well  in  the  Koyal  Pump  Koom,  and  the  strong  Montpelier  Sulphur  Well  in 
the  Montpelier  Gardens.  Tliey  are  both  impregnated  with  sulphuretted  hydrogen  gas 
(upwards  of  25  cubic  inches  in  the  gallon ;  their  chief  salts  being  chlorides  of  sodium, 
calcium,  potassium,  and  magnesium,  sulphide  of  sodium,  and  carbonate  of  lii^,  with 
traces  vi  bromide  of  sodimn,  iodide  of  sodium,  &c.  The  waters  are  alterative,  aperient, 
stimulant,  and  diuretic:  they  are  taken  internally,  and  used  as  baths. 

2.  Mild  Sulphurous  Springs  with  Alkaline  Impregnations. — The  two  most 
important  are  the  mild  Montpelier  Well,  and  the  one  at  the  Victoria  Gardens.  They 
contain  much  less  sulphuretted  hydrogen,  less  chloride  of  sodium,  and  less  chloride  of 
magnesium  than  those  of  the  preceding  group;  but  they  have  in  addition  carbonate  of 
■magnesia.  They  are  antacid,  alterative,  diuretic,  and  deobstruent ;  and  are  used 
externally  as  wdl  as  internally. 

3.  Salink  (Jiialyhkate  Waters. — One  of  these  springs  is  in  the  Cheltenham 
Pump  lioom,  the  other  in  the  Montpelier  Gardens.  In  iiddition  to  the  salts  already 
mentioned  they  contain  carbonate  of  iron,  so  that  they  have  a  tonic  action,  superadded 
to  their  other  properti(!S. 

4.  Pure  Chalyheate  Waters. — The  springs  of  the  Tewhit  and  St.  John's  Well 
have  almost  the  comjiosition  of  pure  water,  with  the  addition  of  a  small  quantity  "of 
carbona.te  of  iron. 

Invalids  with  all  forms  of  chronic  disease  visit  Harrogate  to  drink  the  waters.  But 
the  cases  most  likely  to  derive  benefit  are  the  following:  Impcu-fect  digestion,  in  men 
too  fond  of  good  living,  where  the  bowels  and  liver  are  inactive  (the  strong  sulphur 
springs) ;  chronic  skin  diseases,  such  as  eczema,  le[)ra,  psoriasis,  pityriasis,  lichen,  «&c. 
(the  sulphur,  beginning  with  the  mild) ;  gouty  and  rheumatic  affections  (the  strong 


MINERAL   WATERS.  385 

sulphur) ;  throatonod  jihthisis,  espooially  in  yoiinff  women  with  disordernd  menstrua- 
tion (the  tnild  sulphur,  alternately  with  the  pure-  ohulybeatej ;  strumous  atl'ections  (the 
saline  chalybeate) ;  and  lupus,  chronic  ulcers,  &c. 


467.  jSpa,  in  Belgium. 

Situated  near  the  frontier  of  Rhenish  Prussia,  in  the  beautiful  valley  of  the  Arden- 
nes, at  the  foot  of  a  steep  mountain  shelterins;  it  from  the  north  winds,  is  Spa.  It 
possesses  the  only  mineral  springs  found  in  Belgium.  The  waters  of  the  principal 
well — the  Pouhon — have  a  temperature  of  52°  F.,  and  are  largely  charged  with  car- 
bonic acid  ;  the  chief  solid  constituents  being  the  bicarbonates  of  soda,  iron,  lime,  and 
viofinesia. 

The  wells  of  the  Sauviniere,  Groesbeck,  Geroustfere,  and  the  Tonnelet  are  situated 
at  short  distances  from  the  town.  Their  waters  are  similar  to  those  of  the  Pouhon, 
but  the  proportion  of  iron  is  smaller.     The  Tonnelet  spring  is  the  most  e;aseous. 

These  gaseous  chalybeate  waters  are  employed  to  the  extent  of  two  or  three  pints 
daily,  commencing  with  a  couple  of  glasses  before  breakfast.  They  impart  power, 
strengthen  the  digestion,  and  are  valuable  in  such  cachectic  and  other  diseases  as 
require  a  ferruginous  tonic. — The  season  is  from  the  commencement  of  May  until  the 
end  of  July. 


468.  Bagneres  de  Bigorre,  in  the  Pyrenees. 

This  celebrated  watering-place  is  situated  at  the  foot  of  the  Pyrenees,  on  the  left 
bank  of  the  Adour,  about  thirty-five  miles  to  the  southeast  of  Pau.  The  season  com- 
mences in  June  and  ends  about  the  middle  of  October. 

The  springs  in  Bagneres  and  its  neighborhood  are  numerous,  and  may  be  divided 
into  three  classes:  1.  The  Saline.  The  temperature  of  these  waters  varies  from 
124°  to  85°  F. ;  the  chief  chemical  products  found  in  them  being  carbonic  acid,  chlo- 
rides of  77iag7iesiuni  and  sodium,  sulphates  of  lime,  soda,  and  jnngnesia,  subcarhonates  of 
lime,  magnesia,  and  iron,  an  infinitesimal  proportion  of  arsenic,  with  resinous  and 
vegetable  extractive  matter,  and  silex.  2.  The  Ferruginous.  There  is  only  one  spring 
of  this  kind,  properly  so  called — la  Fontaine  Ferrugineuse.  3.  The  Sulphurous. 
Only  one  sulphurous  spring  has  much  reputation, — that  of  Lebassere ;  and  its  waters 
contain  a  minute  quantity  of  carbonic  acid,  hydro-sulphuric  acid,  chloride  of  sodium, 
hydro-sulphate  of  soda,  subcarboyiate  of  soda,  vegcto-animal  matter,  and  silex. 

The  general  etfect  of  the  waters,  taken  internally  and  as  baths,  is  that  of  a  stimulant 
to  the  mucous  membranes,  kidneys,  lymphatic  system,  and  skin.  They  are  useful, 
more  particularly,  in  diseases  of  the  bones  and  articulations ;  in  chronic  rheumatism, 
and  allied  disorders,  as  neuralgia,  sciatica,  &c.  ;  in  atonic  dyspepsia  from  over-mental 
work  ;  and  in  nervous  affections, — hysteria,  palpitations,  hypochondriasis,  gastrodynia, 
&c.,  especially  if  there  be  biliary  derangements.  The  Labassere  waters  are  beneficial 
in  cases  of  excessive  secretion  from  the  mucous  canals,  in  many  skin  diseases,  and  in 
some  morbid  states  of  the  abdominal  viscera.  In  an;emic  conditions,  valuable  -elfects 
result  from  the  employment  of  the  ferruginous  spring. — Patients  who  have  been 
benefited  by  Pau  during  the  winter  may  advantageously  proceed  to  Bagnbres  for  the 
summer. 

When  the  saline  waters  are  taken  for  their  alterative  eff'ects,  the  daily  dose  is  small — 
about  a  pint;  but  if  a  purgative  action  is  needed,  from  one  to  two  quarts,  in  divided 
quantities,  should  be  drunk  daily. 

469.   Caphern,  in  the  Pyrenees. 

Situated  about  ten  miles  from  Bagnferes  de  Bigorre,  the  waters  of  Capbern  are  of  a 
saline  character  like  most  of  those  of  that  neighborhood.  Their  chief  constituents  are 
carbonic  acid  gas,  sulphates  of  lime  and  mngnesin,  with  carbonate  of  lime.  One  authority 
says  that  they  also  contain  carbonate  of  iron,  while  another  asserts  that  there  is  not  a 
trace  of  it.  They  are  deemed  useful  in  congestions  of  internal  organs,  and  are  sup- 
posed to  have  warded  otf  apoplectic  seizures,  when  the  cerebral  circulation  has  been 
sluggish  :  they  stimulate  the  uterus  and  ovaries,  and  have  been  said  to  cure  sterilitv: 
while  many  cases  of  chlorosis,  leucorrhcea,  dysmenorrhcea,  &c.,  seem  to  have  been 

25 


386  APPENDIX   OF   FORMULA. 

benefited  by  them.  The  dose  is  from  four  to  six  tumblers,  early  in  the  morning, 
taking  exercise  between  each  glass.  At  the  same  time  reclining  or  douche  baths  are 
employed. 

470.  Bareges^  in  the  Pyrenees. 

This  village,  on  the  Gave  de  Bastan,  about  forty-seven  miles  from  Pau,  is  nearly 
4000  feet  above  the  sea. — The  season  lasts  from  the  beginning  of  June  to  the  middle 
of  September. 

The  well-known  sulphurous  and  stimulating  waters  of  Barfeges  are  of  three  kinds, 
as  regards  temperature:  viz.,  the  hot  source,  the  temperate,  and  the  tejnd.  The  princi- 
pal baths  are,  the  Bain  de  l'Entree,  107°  F. ;  Bain  du  Fond,  98°;  Bain  de  Pol- 
ARD,  101° ;  and  Bain  de  la  Chapelle,  84°.  The  waters  of  all  are  limpid,  have  an 
oily  nauseous  flavor,  and  exhale  an  odor  of  rotten  eggs.  They  contain  nitrogen,  sul- 
phuret  of  sodium,  sulphate  of  soda,  chloride  of  sodimn,  silica,  lime,  &c.  On  their  sur- 
face is  found  a  thin  pellicle  called  barlgine  or  glairine;  which  is  probably  of  a  vegeta- 
ble character,  and  is  supposed  to  have  some  peculiar  power  in  curing  chronic  rheu- 
matism. 

These  waters  are  beneficial  in  inveterate  squamous,  pustular,  and  papular  skin 
affections;  in  some  forms  of  scrofula;  in  chronic  rheumatism,  sciatica,  lumbago,  and 
stiffness  of  the  muscles  or  tendons;  in  strumous  and  other  indolent  ill-conditioned 
ulcers;  and  in  irritation  from  the  presence  of  carious  or  necrosed  bone.  Por  healing 
sinuses  left  by  old  gun-shot  wounds  they  are  considered  particularly  efiicacious.  Pul- 
monary cases  derive  more  benefit  from  Eaux-Bonnes  and  Cauterets.  And  the  waters 
of  Barfeges  are  not  to  be  prescribed  where  there  is  any  tendency  to  inflammatory  dis- 
orders, or  in  heart  disease,  or  for  irritable  nervous  temperaments.  They  are  more 
powerful  and  stimulating  than  the  waters  of  St.  Sauveur. 

The  waters  are  taken  internally,  as  well  as  employed  in  the  form  of  baths,  douches, 
lotions,  and  injections. 

471.  St.  Sauveur,  in  the  Pyrenees. 

Situated  on  the  Gave  de  Pau,  in  the  valley  of  Laverdan,  this  watering-place  is 
44  miles  from  Pau,  4  from  Bareges,  and  1  from  Luz.  The  still  Alpine  air  is  mild, 
and  yet  bracing.     The  season  is  from  May  until  October. 

The  waters  are  milder  than  those  of  Barfeges,  but  have  the  same  constituents.  They 
are  useful  for  women  and  children,  in  the  same  disorders  as  are  sent  to  Bareges. 
Hysteria,  neuralgia,  hypochondriasis,  leucorrhoea,  and  irregularities  of  the  catamenial 
flow,  are  much  benefited  by  them.  When  taken  internally  they  have  to  be  diluted, 
their  greasy  properties,  from  the  excess  of  bardgine,  being  so  great.  They  are  mostly 
used  as  reclining  and  douche  baths,  vaginal  injections,  &c. 

472.  Bagneres  de  Luchon,  in  the  Pyrenees. 

This  little  town,  in  a  magnificent  valley  surrounded  by  noble  mountains,  is  85 
miles  from  Pau,  and  2000  feet  above  the  sea.     The  season  lasts  from  May  to  October. 

There  are  upwards  of  48  thermal  sulphurous  springs,  the  temperature  of  the  waters 
varying  from  152°  to  62°  F.  Their  chief  constituents  are  sulphuret  of  sodium,  chloride 
of  sodium,  silicate  of  lime,  and  silica;  with  traces  of  the  stiiphurets  of  iron  and  man- 
ganese, iodide  of  sodium,  sulphate  of  potash  and  soda,  and  sulphite  of  soda,  &c.  They 
are  efficacious  in  chronic  skin  diseases,  in  stiftness  of  limbs  after  dislocations  and  frac- 
tures, in  old  ulcers,  chronic  bronchitis,  rheumatism  and  neuralgia.  Also  in  some 
cases  of  torpid  digestion,  anaemia,  hypochondriasis,  hysteria,  &c.  Their  effects  are 
injurious  when  tliere  is  a  tendency  to  plethora  and  nervous  irritability.  They  are 
drunk,  in  doses  of  three  or  four  glasses,  pure  or  mixed  with  milk;  and  are  used  as 
baths,  injections,  lotions,  eye-washes,  «&c. 

473.    Cauterets,  in  the  Pyrenees. 

This  celebrated  watering-place,  imbedded  among  the  mountains,  in  the  valley  of 
Lavedan,  3057  feet  above  the  level  of  the  sea,  and  more  sheltered  than  Barfeges,  is 
much  frequented  by  Spanish  invalids.  July  and  August  are  the  best  months,  but 
September  is  also  good.  There  are  some  32  sulphuretted  saline  springs,  the  tempera- 
ture of  the  warmest  being  122°  F. 


MINERAL  WATERS.  387 

Some  of  the  waters  are  very  stimulatinc:,  causing  headache  and  fcverishness.  They 
ntain  niirogen,  sulp/inret  of  sodium,  sulphnie  of  soda,  chloride  of  sodium,  si/irn,  hari- 
e,  »&c.  They  are  not  to  be  used  whcire  there  is  any  tendency  to  inflammatory 
actions.  The  cases  most  benefited  are  clironic  derangements  of  digestive  organs, 
•onic  rhevmiatism  and  rheumatoid  arthritis,  chronic  skin  diseases,  uterine  conges- 
'is  or  irritations,  bronchial  catarrli,  tlie  early  stages  of  phthisis,  and  struiiu^us  af- 
'ions.     The  waters  are  often  taken  diluted  in  milk. 

'he  baths  are  especially  valuable  in  rheumatic  affections,  scrofula,  and  obstinate 
1  diseases. 

474.  Eaux-Bonnes,  in  the  Pyrenees. 

laux-Bonnes,  a  village  in  a  sheltered  valley  at  the  foot  of  the  Pic  de  Gers,  is  22 
es  from  Pau.  The  air  is  remarkably  pure  and  fresh.  The  mineral  waters,  of 
eh  the  supply  is  scanty,  have  been  deemed  efficacious  in  the  early  stages  of  tuber- 
ir  and  other  chronic  diseases  of  the  respiratory  organs.  They  are  likewise  useful 
crofula  generally,  in  chlorosis,  in  dyspepsia  from  want  of  tone,  and  in  amenorrhoea. 
!  springs  are  slightly  alkaline,  and  contain  chloride  of  sodimn,  sulphates  of  lime  and 
X,  iodide  of  sodium,  &c.  Their  temperature  is  about  90°  F.  The  sulphurous  waters 
mildly  stimulating;  and  are  taken  internally,  and  less  frequently  applied  in  the 
n  of  baths.  In  the  commencement  only  small  doses  (three  ounces)  should  be 
i\\,  the  quantity  being  gradually  increased  to  three  or  four  glasses  of  six  ounces 
1.  While  undergoing  treatment  the  patient  is  encouraged  to  live  as  much  in  the 
n  air  as  his  symptoms  will  permit.  A  residence  of  about  a  month,  for  one  or  two 
ons  (the  season  lasts  from  June  to  the  middle  of  September)  is  generally  deemed 
icient.  Afterwards  a  trip  to  Biarritz,  for  the  enjoyment  of  sea-bathing,  may 
3n  be  taken  with  advantage. 

475.  Uaux-Chaudes,  Pyrenees. 

Mie   position  of  this   village,  hemmed  in  by  precipitous   limestone  cliffs,  is   wild 
I  secluded.     It  lies  about  26  miles  from  Pau,  and  4  from  Eaux-Bonnes.     The  sea- 
lasts  from  the  beginning  of  July  until  the  end  of  October. 

)f  the  six  springs  some  are  used  for  baths,  others  as  internal  remedies.  The  hot- 
,  source  is  Le  Clot  (96)°;  while  L'Esquirette  has  the  largest  amount  of  salts. 
3  waters  contain  sulphuret  of  sodium,  sulphate  of  lime,  and  silica. ^  They  deposit 
i^uraire,  a  gelatinous  substance  probably  consisting  of  confervas.  Their  taste  is 
igreeable,  the  smell  of  rotten  eggs  being  powerful. 

'he  waters  (two  to  six  glasses  early  in  the  morning)  and  baths  are  useful  in  rheu- 
tism  and  sciatica,  in  neuralgia,  in  threatened  pulmonary  disease,  in  scrofula,  and 
itonic  dyspepsia. 

476.    Ussat,  in  the  Pyrenees. 

'he  mineral  baths  of  Ussat,  in  the  Department  of  the  Ariege,  are  70  miles  from 
ilouse,  the  inhabitants  of  which  city  value  them  highly.     They  contain  about  11 
ins  of  solids  4o  the  pint, — chiefly  sulphates  and  carbonates  of  lime  and  magnesia,  and 
)ride  of  sodium,  with  traces  of  arsenic.     The  waters  belong  to  the  acidulous  ther- 
l  class;  are  not  at  all  unpleasant;  are  soothing  to  the  nervous  system;    and  hence 
pruve  useful  in  hypochondriasis,  hysteria,  chorea,  paralysis  agitans,  neuralgia,  cramp, 
muscular  pains,  dysmenorrhoea,  irritable  conditions  of  uterus,  &c.      Though  some- 
times taken  internally,  they  are  chiefly  used  as  baths.     The  season  lasts  from  June  to 
October. 

477.  Vernet  les  Bains,  in  the  Eastern  Pyrenees. 

The  little  village  of  Yernet,  16  miles  from  Perpignan,  is  placed  in  a  deep  well- 
sheltered  valley.  The  waters  belong  to  the  thermal  sulphurous  class,  but  are  only 
feebly  charged  with  solids — amongst  others,  sulphuret  of  sodium. 

"Where  a  long  course  of  weak  sulphur  waters  is  needed,  these  baths  maybe  resorted 
to  in  the  winter  as  well  as  in  the  summer  months.  Sunny  walks  may  be  had  on  most 
days  in  winter.  The  waters  are  taken  internally,  and  employed  as  warm  and  vapor 
baths ;  and  this  combination  of  drinking  and  bathing  is  thought  efficacious  in  chronic 
chest  afl'ections. 


388  APPENDIX   OF   PORMUL^. 


478.  Panticosa,  in  Arragon. 

This  remarkable  Spanish  watering-place,  56  miles  from  Pau,  is  situated  at  a  level 
of  8500  feet  above  the  sea.  It  is  romantically  placed  in  one  of  the  little  green  valleys 
of  the  Pyrenees;  being  surrounded  by  the  lofty  granite  mountains,  except  at  one 
part  through  which  flows  the  river  Caldares.  There  are  four  springs;  two  being 
saline,  one  sulphurous,  and  one  ferruginous.  The  chief  source  is  the  Fuente  del 
HiGADO,  which  contains  nitrogen  in  large  quantity,  with  feeble  proportions  of  sul- 
phaie  of  soda,  chloride  of  sodium,  carbonate  of  lime,  chloride  of  magnesium,  and  silica. 
Its  waters  are  agreeable,  have  a  temperature  of  81°  P.,  and  numerous  gas  bubbles 
(owing  to  its  free  nitrogen)  escape  with  it. 

The  waters  taken  internally  increase  the  secretions  of  the  kidneys  and  skin  ;  pro- 
duce a  sedative  eUect  on  the  system  ;  increase  the  appetite  and  general  powers;  and 
in  pulmonary  cases,  relieve  the  cough.  They  are  particularly  recommended  in  laryn- 
geal phthisis,  in  hemorrhage  from  lungs  or  stomach  or  uterus,  and  in  chronic  irrita- 
tion of  the  bronchial  or  intestinal  mucous  membranes.  Where  there  is  softened 
tubercle,  or  much  debility  of  system,  they  do  harm.  The  best  part  of  the  season  is 
from  the  beginning  of  July  to  the  end  of  August. 


Bicarb,  soda,  grs.  .37. .50 

Carbonic  acid  gas,  grs.  6.97  to  each  16  ozs. 

"                    3909 

5.91 

"                    3860 

8.21 

39.19 

«'                        804             " 

»                    37.57 

«                       6.71             " 

«                   36.99 

«                      20.92 

479.  Vichy,  in  Central  France, 

This  important  alkaline  thermal  bath  is  situated  on  the  right  bank  of  the  Allier, 
in  a  large  open  valley,  surrounded  by  hills  covered  with  vineyards.  The  air  is  tem- 
perate and  pure.     The  season  lasts  from  the  middle  of  May  to  the  15th  September. 

The  springs  used  at  Yichy  for  drinking  and  bathing  are  nine  in  number;  the 
waters  of  all  being  limpid,  and  having  somewhat  the  taste  of  soda  water.  Bicarbonate 
of  soda  and  carbonic  acid  gas  form  the  predominating  ingredients  ;  but  they  also  con- 
tain small  quantities  of  the  bicarbonates  of  potash  and  magnesia,  with  the  arseniate  of 
soda.  There  is  also  some  barigi.ne,  most  abundant  at  the  Source  de  I'Hopital.  The 
proportion  of  chief  chemical  components,  in  the  sources  generally  resorted  to,  is  shown 
in  the  following  table  : 

Grande  Grille, 107.R°  F. 

Puits-Chnmel 109  6° 

Fontaine  del'Hopital,  .     .  89° 

Fontaine  des  Celestins,     .  58.6° 

Grand  Puits  Carr6,  .    .    .  110.5° 
Puits  d'Hauterive,    .    .    .      59° 

"Wherever  the  use  of  strongly  alkaline  waters  is  indicated,  those  of  Vichy  will 
prove  useful.  They  may  be  taken  internally,  or  employed  as  baths ;  or  used  in  both 
waj's  at  the  same  time.  The  diseases  which  derive  most  benefit,  are, — pulmonary 
catarrh  ;  debility  and  irritability  of  the  digestive  organs  ;  chronic  enlargement  of  the 
liver  and  spleen ;  uric  acid  gravel  and  calculi ;  vesical  catarrh  ;  chfonic  gout  and 
rheumatism;  diabetes;  and  some  cases  of  albuminuria.  Obesity  has  been  lessened 
by  these  waters;  and  they  might  be  employed  with  advantage  where  the  blood  con- 
tains an  excess  of  fibrine. — The  dose  is  from  half  a  pint  to  two  pints  daily ;  but  they 
must  not  be  continued  too  long,  lest  a  super-alkaline  condition  of  the  blood  be 
induced. 

The  Vichy  waters  are  exported  in  considerable  quantities,  and  it  is  supposed  with- 
out their  undergoing  any  deterioration. 

480.  3Iont  jy  Or,  in  Central  France. 

At  this  bath  there  are  six  thermal  sources  and  one  cold  spring.  The  water  of  the 
latter,  St.  Marguerite,  is  acidulous  from  the  carbonic  acid  it  contains,  has  a  tempera- 
ture of  52°  P.,  and  is  an  agreeable  drink  mixed  with  milk  or  wine.  The  thermal 
sources  are  Le  Grand  Baix  (108°  P.),  the  Source  of  C^.sar  (113°),  the  Pountain 
Caroline  (107°),  the  Bain  Eaymond  (109°),  the  Eigny  (109°),  and  the  Madeleine 
(ll4°).  The  ingredients  in  the  different  waters  only  vary  in  quantity;  consisting  of 
the  carbonates  of  soda  and  lime,  chloride  of  sodium,  sulphate  of  soda,  with  mere  traces 
of  iron  and  alumina.  They  all  contain  an  excess  of  carbonic  acid.  The  Madeleine 
spring  is  also  strongly  arsenical. 


MINERAL   WATERS.  389 

Besides  drinkins^  the  waters,  most  invalids  employ  warm  batiiing.  The  effect  is  to 
increase  the  perspiration  ;  and  at  the  end  of  a  few  days  to  produce  "  the  bath-fever" 
(lassitude,  depression,  constipation,  &c.),  which  soon  passes  oft".  The  invalids  who 
will  derive  benefit  from  a  visit  to  Mont  D'Or  are  such  as  have  chronic  pulmonary 
catarrh,  some  kinds  of  asthma,  rlununatistn,  and  conj^estion  of  the  liver.  Miscliief 
will  result  to  persons  of  a  languid  circulation,  and  such  as  have  a  tendency  to  hemor- 
rhage. 

The  season  is  from  the  middle  of  July  to  the  end  of  August;  but  the  waters  should 
not  be  used  for  more  than  a  fortnight,  on  account  of  their  exciting  properties.  The 
visitors  who  drink  them,  take  three  or  four  glasses  daily. 


481.  Neris,  in  Central  France. 

The  thermal  springs  of  Neris  are  resorted  to,  from  May  until  October,  for  the  pur- 
pose of  drinking  the  waters,  and  bathing  in  them.  There  are  four  wells ;  the  tem- 
perature of  the  waters  at  their  source  being  about  120°  F.  They  are  insipid  and  oily  ; 
containing  only  small  j)roj)ortions  of  carhotiic  acid,  bicarbonate  of  Sdda,  sidpfiafe  of 
soda,  and  c/i/onde  of  sudiuin.  Conferva?  grow  freely  in  the  basins.  These  waters  are 
recommended  in  cases  of  nervous  and  hysterical  excitement,  in  rheumatism,  and 
prurigo. 

482.  St.  Gralmier,  in  Central  France. 

These  waters,  owing  to  their  richness  in  carbonic  acid  gas,  are  agreeable  whether 
taken  pure  or  mixed  with  wine;  while  thej'  have  the  property  of  hastening  diges- 
tion, increasing  the  appetite,  and  augmenting  absorption  from  the  alimentary  canal. 
The  chief  salts  in  them  are  the  bicarbvna.tes  of  lime  and  magnesia. 

The  St.  Galmier  waters  are  cold,  and  resemble  Seltzer  water.  They  are  in  common 
use  at  Lyons  ;  being  deemed  useful  in  gastric  aflectious,  and  for  preventing  the  form- 
ation of  urinary  calculi. 


483.  Aix-la- Chapelle,  in  Rhenish  Prussia, 

This  handsome  city,  40  miles  W.S.W.  of  Cologne,  is  situated  in  a  valley  between 
the  Rhine  and  Maas  rivers,  and  is  surrounded  by  well-wooded  hills.  The<re  are  eight 
principal  springs, — six  thermal  and  slightly  sulphurous,  and  two  cold  chalybeate.  Their 
therapeutical  etiects  are  due  to  the  high  temperature  of  the  water  (varying  from  111° 
to  131"  F.),  and  the  sidpfmr  and  chloride  of  sodium  contained  in  it.  The  latter  salt  is 
found  in  the  proportion  of  about  20  grains  to  the  16  ounces:  while  the  sulphuret  of 
sodium  varies  from  three-quarters  to  a  quarter  of  a  grain. — The  chalybeate  springs  are 
sometimes  emploj'ed  as  an  "after-cure;"  but  they  have  little  power,  one  containing 
half,  and  the  other  three-quarters  of  a  grain  of  iron  in  the  sixteen  ounces,  with  some 
carbonic  acid. 

In  doses  of  a  few  glasses  these  clear  transparent  waters  produce  hut  little  apprecia- 
ble effect ;  their  chief  use  being  externally, — as  vapor  baths,  douches,  shampooing,  &c. 
They  have  considerable  reputation  for  curing  scrofula,  skin  diseases,  ulcers,  and  gun- 
shot wounds. — The  season  begins  in  June  and  ends  about  the  middle  of  September. 

484.  Kreuznach,  in  Rhenish  Prussia. 

The  rather  nauseous  and  bitter  waters  of  this  Spa  have  a  considerable  reputation 
for  the  cure  of  uterine  diseases,  as  well  as  of  most  scrofulous  afiections.  The  chief 
waters  are  those  of  the  Elizabeth  Brunnen,  having  a  temperature  of  54.50^  F. 
They  contain  about  90  grains  of  solid  constituents  in  16  ounces  ;  chiefly, — chloride  of 
sodium,  {IZ),  chloride  of  calcium  (13J,  chloride  of  magnesium  (4),  bromide  of  magnesium 
{^),  oxide  of  iron  (^),  with  a  trace  of  iodide  of  magnesium,  &c.  The  Karlshalleb 
WATER  has  a  temperature  of  59'',  and  75  grains  of  salts  in  the  sixteen  ounces;  the 
Theodorshalle,  70.25°,  and  87  grains;  while  for  the  chief  well  of  Munster  the 
numbers  are  81. 50*^,  with  from  64  to  76  grains. 

In  drinking  the  water  it  is  better  to  begin  with  small  quantities,  which  may  be 


390  APPENDIX   OF   FORMULA. 

drunk  pure  or  mixed  with  hot  milk.  The  baths  are  generally  taken  tepid;  "mother- 
lye"  (the  brownish  or  glutinous  liquid  left  in  the  boiling  pans,  after  the  salt  has  been 
crystallized  and  removed)  being  added  to  the  water,  in  proportions  suitable  to  the  re- 
quirements of  each  case.  In  uterine  atiections,  fomentations  and  vaginal  injections 
are  employed  in  addition  to  the  baths. 

The  Kreuznach  waters  have  proved  valuable  in  congestions  of  the  uterine  organs ; 
as  well  as  in  chronic  inflammatory  affections  of  these  parts,  in  hypertrophy  and  indur- 
ation, in  uterine  displacements,  and  in  derangements  of  the  menstrual  functions. 
Dr.  Prieger,  who  has  had  very  great  experience  in  the  use  of  these  waters,  tells  the 
author  that  he  has  never  seen  a  true  fibroid  tumor  of  the  uterus  absorbed  through 
their  influence ;  but  when  such  a  growth  is  cedematous  or  congested,  the  waters  re- 
lieve these  complications. 

The  season  extends  from  the  end  of  April  until  the  beginning  of  October.  The 
stay  which  a  patient  should  make  may  vary  from  six  to  eight  weeks. 

The  springs  of  Nauheim,  a  village  of  Hessen-Cassel,  resemble  those  of  Kreuznach, 
except  that  they  contain  rather  more  chloride  of  sodium,  only  a  trace  of  bromide  of 
magnesium,  and  none  of  the  iodide  of  magnesium.  There  is  also  an  abundance  of 
carbonic  acid ;  and  the  temperature  of  the  four  chief  springs  varies  from  72°  to  92°  F. 
The  waters  are  drunk  and  used  as  baths ;  while  like  those  of  Kreuznach,  they  are  re- 
commended for  all  strumous  affections. 

485.  NeuenaJir^  in  Hhenish  Prussia. 

This  village,  in  the  valley  of  the  Ahr,  is  easily  reached  from  Cologne.  Of  the 
springs,  the  Victoria  is  the  best.  Mr.  Miller,  the  late  Professor  of  Surgery  in  the 
University  of  Edinburgh,  says  that  it  is  the  richest  of  all  known  brunnens  in  carbonic 
acid.  It  furnishes  some  29,792  cubic  feet  of  water  daily ;  an  analysis  of  which  has 
shown  the  presence  of  small  quantities  of  bicarbonate  of  soda,  sulphate  of  soda,  chloride 
of  sodium,  bicarbonate  of  magnesia,  bicarbonate  of  lime,  protoxide  of  iron  and  alumina, 
silica,  and  free  carbonic  acid. 

The  waters  are  taken  internally  and  applied  externally.  The  dose  is  from  two  to 
five  tumblerfuls,  early  in  the  morning  ;  with  half  the  quantity  in  the  evening.  The 
temperature  of  the  water  is  between  78°  and  80°  F.  ;  and  the  taste  is  pungent  and 
pleasant,  resembling — as  an  English  valet  said — "Seltzer  water  with  the  chill  off." 
The  best  time  for  the  bath  is  two  or  three  hours  after  breakfast ;  the  temperature  of 
the  water  being  about  88°  F.,  and  the  time  for  remaining  in  it  twenty  minutes. 
When  the  invalid  is  acclimatized,  the  douche  may  be  used  if  needful. 

The  waters  are  tonic  and  anti-rheumatic ;  acting  especially  on  the  mucous  mem- 
branes and  the  glandular  system.  They  are  useful  in  simple  dyspepsia,  diminished 
secretion  of  bile,  irritability  of  bladder  with  excess  of  uric  acid  in  the  urine,  chronic 
gout  and  rfieumatism,  asthma  uncomplicated  with  organic  disease,  chronic  aflections 
of  larynx  or  bronchi,  eczema  and  prurigo,  and  chronic  uterine  maladies. — In  a  person 
apparently  healthy  Dr.  Weidgen  found  that  the  use  of  the  waters  was  followed  by 
these  eflects :  A  sense  of  warmth  in  the  stomach  soon  after  drinking  ;  exhilaration ; 
increased  flow  of  urine;  increased  appetite;  and  increased  salivary  and  bronchial  se- 
cretions. After  a  week  the  bowels  were  affected  ;  copious,  soft,  bilious  evacuations 
being  produced.     The  urine  became  neutral,  but  never  alkaline. 


486.  JEms,  Duchy  of  Nassau, 

Ems,  or  Bad-Ems  (as  the  Spa  is  called,  to  distinguish  it  from  the  village),  lies  on 
the  right  bank  of  the  sluggish  Lahn,  inclosed  in  a  narrow  valley  between  high  moun- 
tains, 16  miles  N.  of  Wiesbaden, — There  are  several  springs.  The  waters  are  alka- 
line, saline,  and  gaseous;  while  the  temperature  varies  from  86°  F.  to  133'^.  The  chief 
constituents  are  bicarbonate  of  soda,  chloride  of  sodium,  and  bicarbonate  of  magnesia; 
with  small  quantities  of  iron,  manganese,  potash,  and  lithia.  Their  action  is  that  of  a 
mild  alterative,  diuretic,  and  laxative ;  and  they  are  believed  to  favorably  influence  all 
catarrhal  aflections  of  the  mucous  membranes. 

The  principal  drinking  springs  are  the  Kkanciienbrunnen  and  the  Kesselbrun- 
NEN.     The  waters  of  the  former  are  clear,  odorless,  have  a  temperature  of  91*  F., 


MINERAL   WATERS.  391 

and  leave  a  soapy  taste  owing  to  the  soda  they  contain.  According  to  Struve  each 
10  ounces  contains  15^  cubic  inches  of  free  carbonic  acid  gas.  The  Kesselbrunnen 
or  Knrbrunnun  waters  give  out  more  carbonic  acid  gas,  and  are  118"  F.  The  dose 
is  from  one  to  six  beakers,  each  liolding  about  4  oz.  In  many  cases  it  is  an  improve- 
ment to  add  one-third  part  of  goats'  or  asses'  milk  to  the  measure. 

The  waters  are  also  employed  externally,  the  baths  being  partly  filled  over-night 
to  lower  the  temperature.  The  Bubenquelle  (boy's  spring),  117°  F.,  is  used  as  a 
vaginal  douche,  and  is  in  repute  for  the  cure  of  sterility. 

The  waters  generally  are  rcicommended  in  bronchial  and  pulmonary  affections,  and 
in  the  dyspepsia  of  such  as  have  only  a  tendency  to  phthisis.  For  the  relief  of  the 
lithic  acid  diathesis  they  are  valuable,  but  less  so  than  those  of  Vichy.  For  drink- 
ing and  bathing,  French  and  German  visitors  usually  resort  to  Ems  in  June.  Our 
own  countrj'inen,  however,  seem  to  prefer  July  and  August;  though  the  narrowness 
of  the  valley  in  which  this  bath  is  situated  causes  the  air  to  be  very  oijpressive  and 
relaxing  during  these  months. 

The  mineral  springs  of  FAcniNGEN,  a  village  9  miles  E.N.E.  of  Nassau,  on  the 
Lahn,  resemble  those  of  Ems,  the  salts  being  present  in  rather  smaller  proportions. 
The  waters  form  an  agreeable  antacid  drink  in  some  forms  of  dyspepsia. 

487.  Sellers,  in  Nassau. 

This  village,  in  a  pleasant  valley  37  miles  N.  of  Wiesbaden,  is  everywhere  famous 
for  its  mineral  springs ;  an  enormous  quantity  of  Seltzer  water  being  annually  ex- 
ported. 

The  water  has  a  temperature  of  60"  F.,  and  contains  much  more  than  its  volume 
of  carbonic  acid  gas.  It  has  about  32  grains  of  solids  in  the  sixteen  ounces  ;  chiefly 
chloride  of  sodium  (18),  and  carbonate  of  soda  (9),  with  minute  quantities  of  suljihate 
of  soda,  lime,  magnesia,  and  iron.  Seltzer  water  stimulates  the  stomach ;  and  is  a 
grateful,  antacid,  slightly  alterative  drink. 

488.  Schwalhach  and  Scldangenhad,  in  Nassau. 

ScHWALBACH  Or  Langensch  WALBACH,  8  miles  N.W.  of  Wiesbaden,  consists  of 
one  long  street,  in  the  middle  of  which  is  the  Kursaal.  The  gaseous  chalybeate  wa- 
ters, with  a  temperature  of  50"  F.,  owe  their  invigorating  properties  to  carbonate  of 
iron,  which  is  held  in  solution  by  an  excess  of  carbonic  acid.  They  also  contain  a 
small  amount  of  the  bicarbonates  of  soda,  magnesia,  and  li7ne.  The  chief  springs  are — 
the  Weinbrunnen,  near  the  Kursaal,  which  contains  most  iron,  and  is  belie s'ed  to 
counteract  the  evils  arising  from  excessive  indulgence  in  wine  ;  the  Paulixenbkun- 
NEN,  the  mildest,  which  is  used  by  invalids  from  tropical  climates  with  torpid  livers  ; 
the  KosENBRUNNEN,  Only  employed  externalh',  the  baths  being  heated  by  steam  to 
86" ;  and  the  Stahlbrunnen,  in  the  northern  valley,  which  is  the  most  exciting  of 
the  springs.  The  waters  are  drunk  fasting,  to  the  amount  of  one  to  three  glasses ; 
and  they  may  be  strongly  recommended  in  cases  of  impaired  strength  where  a  ferru- 
ginous tonic  is  indicated.  The  bath  should  be  taken  about  two  hours  after  breakfast, 
omitting  its  use  every  third  or  fourth  day.  The  best  time  for  a  visit  to  Schwalhach 
is  from  the  middle  of  June  until  the  end  of  August. 

Eather  more  than  2  miles  from  Schwalhach,  in  a  pleasant  valley,  with  romantic 
environs,  is  Schlangenbad.  The  climate  is  pure  and  bracing ;  but  as  a  Spa  it  is  of 
insignificant  value,  owing  to  the  small  amount  of  solid  constituents — only  a  few 
grains  of  carbonate  of  soda,  lime,  and  magnesia,  with  commo7i  salt — in  the  waters. 
W^arm  saline  and  mud  baths  are  used  by  the  visitors;  such  amusements  being  in  re- 
pute for  softening  and  whitening  ("satinizing")  the  skin,  and  for  allaying  nervous 
irritability. 

489.    Wiesbaden,  in  Nassau. 

Wiesbaden,  the  capital  of  the  Duchy  of  Nassau,  lies  on  the  southern  slope  of  the 
Taunus  mountain,  5  miles  N.N.W.  of  Mayence.  It  is  the  most  frequented  of  the 
watering-places  in  Germany.  The  season  extends  from  June  until  September,  but 
it  is  very  hot  in  July  and  August.  Owing  to  the  shelter  aftbrded  by  the  sevei'al 
peaks  of  the  Taunus,  the  autumnal  and  winter  climate  is  good. 

There  are  some  eighteen  or  twenty  thermal  springs,  but  only  one  is  of  much  im- 
portance. This,  the  Kochbrunnen,  appears  literally  to  resemble  a  boiling  well. 
The  temperature  reaches  IGO"  F.,  volumes  of  vapor  are  emitted,  and  the  water  con- 


392  APPENDIX    OF   FORMULA. 

tains  somo  63  grains  of  solids  in  the  sixteen  ounces.  The  salts  are  chloride  of  sodium 
(52^) ;  with  small  quantities  of  poiash,  lime,  iron,  magnesia,  arseniate  of  lime,  bi'omide 
of  magnesiutn,  &c.  The  carbonic  acid  gas  is  one-fifth  of  the  bulk  of  the  water.  Dr. 
Granville  compares  the  taste  to  that  of  weak  chicken-broth  slightly  salted.  Taken 
in  a  dose  of  three  or  four  glasses,  cooled,  before  breakfast,  it  has  a  sliglitly  laxative 
effect,  and  increases  the  appetite.  As  baths,  at  a  temperature  varying  from  86®  to 
98",  about  two  hours  after  a  light  breakfast,  the  waters  are  somewhat  soothing,  while 
they  increase  the  action  of  the  skin  and  kidneys. 

The  cases  in  which  these  waters  are  likely  to  prove  valuable,  are  chronic  gout  and 
rheumatism,  hepatic  congestion  with  haemorrhoids,  and  chronic  skin  disease  con- 
nected with  abdominal  plethora.  They  will  be  injurious  in  debility,  in  congestion  of 
the  uterine  organs,  or  where  there  is  a  tendency  to  apoplexy  or  any  other  form  of 
hemorrhage.  The  invalid  maj-  know  that  they  disagree,  when  prostration,  loss  of 
appetite,  constipation,  irritability,  and  palpitations  are  produced. 

490.  Soden,  in  Nassau. 

The  waters  of  Soden,in  the  Taunus  near  Frankfort,  are  saline  and  gaseous,  issuing 
from  twenty-three  springs,  scattered  through  the  village.  Their  temperature  varies 
from  64°  to  75<^  F. 

The  most  important  springs  are, — the  Milchbkunnen  containing  23  grains  of 
solids  in  the  sixteen  ounces;  17  grains  being  chloride  of  sodium,  8  chloride  of  potas- 
sium, with  17  cubic  inches  of  carbonic  acid  gas.  The  "VVarmbrunnen  has  35  grains 
of  solids,  26  of  which  are  chloride  of  sodium ;  the  carbonic  acid  gas  being  35  cubic 
inches.  The  Wilhelmsbruknen  has  117  grains  of  salts,  104  being  chloride  of  so- 
dium, with  48  cubic  inches  of  gas.  Whilst  "the  Soolbri^nen  has  129  grains,  114  of 
which  consists  of  the  same  salt  that  predominates  in  the  others,  together  with  14 
cubic  inches  of  gas. — Where  alterative  aperients  are  needed,  these  waters  may  per- 
haps be  recommended.  They  are  deemed  useful  in  pulmonary,  strumous,  gouty,  and 
uterine  aflections. 

One  advantage  possessed  by  Soden  is  the  presence  of  the  two  ferruginous  springs  of 
Kroxthal  ;  so  that  the  visitor  having  employed  the  alteratives  of  the  first  !Spa,  may 
strengthen  the  system  with  the  mild  chalybeates  of  the  Stahlquelle  or  Wilhelms- 
quelle.     The  climate  of  Xronthal  is  useful  in  chronic  bronchial  affections. 

491.  Somburg,  in  Nassau. 

The  air  of  Homburg  is  invigorating  and  bracing  during  the  months  of  June,  July, 
and  August;  but  it  is  injurious  to  such  as  have  delicate  lungs,  owing  to  the  tempera- 
ture being  very  variable.  There  are  four  cold  (about  50°  F.)  muriated  mineral 
springs.  The  most  frequented  is  the  Elizabkthquelle,  containing  about  110  grains 
of  salts  in  the  16  ounces,  and  being  strongly  charged  with  carbonic  acid  (48  cubic 
inches).  The  chief  salts  are  chloride  of  sodium  (79),  the  chlorides  of  magtiesium  and 
calcium  (15),  and  carbonate  of  Zwne  (11);  with  small  quantities  of  carbonate  of  mag- 
nesia, sulphate  of  soda,  carbo7iate  of  iron,  and  silica.  The  Kaiserquelle  has  more 
chloride  of  sodium.  (117),  more  chloride  of  calcium,  and  a  little  more  iron.  The  Stahl- 
quelle has  the  same  amount  of  common  salt  as  the  Elizabeth  spring,  but  is  more 
ferruginous  than  either  of  the  others.  While  the  Ludwigsquelle  is  weak  in  al- 
most all  its  constituents.  The  flavor  of  all  the  waters  is  refreshing,  saltish,  somewhat 
bitter,  and  ferruginous. 

Gout,  dyspeptic  and  other  derangements  of  the  abdominal  viscera,  strumous  en- 
largements of  the  external  glands  and  mesentery,  debility  of  the  reproductive  organs, 
constipation,  obesity,  and  hypochondriasis,  are  the  diseases  most  likely  to  be  benefited. 
From  two  to  four  tumblerfuls  of  the  waters  are  taken  fasting  during  three  or  four 
weeks.     Though  chiefly  used  internally,  there  are  baths,  douches,  &c. 


492.  Baden-Baden.)  in  Grand  Ducky  of  Baden. 

This  renowned  Spa,  in  one  of  the  most  delightful  valleys  of  the  Black  Forest,  about 
six  miles  from  the  Khine,  has  16  weak  saline  springs,  the  temperature  of  which  varies 
from  117°  to  161°  F.     The  chief  spring,  and  the  only  one  demanding  notice,  is  the 


MINERAL    WATERS.  393 

Ursprung  ;  which  has  a  transparent,  inodorous  saltish  water.  Its  chemical  constitu- 
ents are  merely  about  23  ejrains  to  the  IG  ouiic<-s,  18  t^rains  beint?  c/doride  of  sodium. 
There  are  also  2i  grains  of  Hnlphale  of  lime,  about  1-lOth  of  a  j^rain  of  carbonate  of 
iron,  with  less  than  half  a  cubic  incli  of  carbonic  acid.  Keeent  analyses  have  shown 
the  presence;  of  lHhia,  in  greater  abundance  than  in  any  other  springs. 

Though  their  efficacy  must  be  slight  these  waters  are  often  taken  internally.  Some 
drinkers  udd  goat's  mi'lk  to  them,  or  whey,  or  aperient  salts.  But  they  are  chiefly  to 
be  employed  where  simple  hot  baths  are  needed,  while  the  invalid  is  enjoying  beauti- 
ful scenery,  in  ]iure  mild  air.  They  may  be  recommended  in  chronic  gout  and  rheu- 
matism.    The  season  Ihsts  from  the  beginning  of  May  until  the  1st  October. 

The  waters  of  Wildbad,  some  thirty  miles  from  Baden-Baden,  and  situated  in  the 
kingdom  of  Wiirtemburg,  contain  only  four  grains  of  salts  in  the  1(5  ounces,  and  have 
a  temperature  varying  from  86°  to  98°  F.  Where  hot  baths  and  douches  are  needed 
in  chronic  paralysis,  rheumatism,  «&c.,  a  six  weeks'  sojourn  at  Wildbad  may  perhaps 
be  recommended.  The  climate  is  very  bleak  from  November  until  May;  and  then 
in  the  four  succeeding  fashionable  months  the  heat  is  most  oppressive. 


493.  Kissingen,  in  Bavaria. 

Kissingen,  one  of  the  most  fashionable  watering-places  of  Germany,  is  situated  in 
a  fertile  valley,  about  30  miles  N.N.E.  of  Wlirtzburg. — The  tonic,  laxative,  and 
alterative  waters  are  all  cold  (about  52°  F.).  The  most  important  spring  is  the  Rag- 
OCZY,  containing  65  grains  of  solids  in  the  16  ounces,  according  to  Liebig,  with  41 
cubic  inches  of  carbonic  acid  gas.  The  principal  salts  are  chloride  of  sodium  (45),  car- 
bonate of  lime  (8),  sidphaie  of  magnesia  (4),  chlorides  of  potassium  and  magnesium  (5), 
with  minute  quantities  of  chloride  of  lithium,  bromide  and  iodide  of  sodium,  and  carbon- 
ate of  iron.  The  waters  of  the  Pandurbrunnen  have  rather  a  smaller  amount  of 
solids ;  while  those  of  the  Maxbrunnen  and  of  the  Theresienbrunnen  are  very 
much  weaker,  and  contain  no  iron. 

The  Kagoczy  spring  is  most  used  early  in  the  morning,  from  three  to  six  glasses 
being  taken.  In  the  evening  the  milder  waters  of  the  Pandur  are  preferred.  The 
efiect  is  to  quicken  the  circulation,  and  to  stimulate  the  secretions  of  the  mucous 
membranes  generally  but  especially  those  of  the  alimentary  canal.  Hence  they  are 
valuable  in  habitual  constipation,  congestion  of  the  liver  or  kidneys,  in  dyspeptic 
eructations  or  flatulence,  and  in  tubercular  diseases  of  the  mesenteric  glands.  Gouty 
and  calculous  cases  also  derive  benefit. 

The  baths  are  prepared  from  the  waters  of  the  wells  just  named,  some  of  the 
"  mother- water"  of  the  Soolensprudel  being  frequently  added.  This  spring  has  a 
temperature  of  62°  F. ;  and  contains  187  grains  of  solids  in  the  16  ounces,  upwards  of 
100  consisting  of  chloride  of  sodium.  The  astonishing  flux  and  reflux  of  the  Sprudel 
is  one  of  the  sights  of  the  town. 

About  A\  miles  from  Kissingen  is  the  Spa  of  Bocklet,  in  Bavaria,  which  contains 
several  chalybeate  and  a  weak  sulphur  si»ririg.  The  temperature  of  the  waters  is 
about  52°  F. ;  while  there  is  rather  more  than  half  a  grain  of  carbonate  of  iron  in  the 
16  ounce^  with  39  cubic  inches  of  carbonic  acid  gas.  They  also  contain  a  small  amount 
of  the  sulphates  of  soda  and  magnesia,  chloride  of  sodium.,  carbonate  of  lime,  &c.  Inde- 
pendently of  the  constant  interchange  of  visitors  between  Kissingen  and  Bocklet,  the 
baths  of  the  latter  (especially  the  "douche  ascendante")  have  a  considerable  reputa- 
tion for  the  cure  of  sterility,  and  for  breaking  oft'  the  tendency  to  habitual  abortion. 

Bruckenatj,  in  Bavaria,  is  also  only  a  few  hours'  drive  from  Kissingen.  The 
waters  contain  scarcely  any  salts,  but  have  about  a  quarter  of  a  grain  of  iro7i  in  the 
16  ounces,  with  at  least  35j  cubic  inches  of  carbonic  acid  gas.  Their  temperature  is 
49°  F.  They  are  often  employed  by  those  who,  after  going  through  a  course  of  the 
solvent  waters  of  Kissingen,  require  a  pure  mild  tonic. 


394  APPENDIX   OF   FORMULA. 


494.   Gastein,  in  Austria. 

A  few  hours'  drive,  from  Salzturg  is  the  village  of  Gastein,  in  the  most  beautiful 
part  of  the  Tyrol.  It  is  one  of  the  highest  baths  in  Europe,  being  3200  feet  above  the 
Mediterranean.  The  houses  are  grouped  round  the  edge  of  the  mountain  torrent 
Ache,  which  here  forms  a  splendid  waterfall.  The  bracing  alpine  air  is  invigorating 
for  such  as  have  strong  lungs,  but  the  climate  is  often  too  raw  and  unsettled  for  the 
delicate  invalid  to  depend  upon  it.     Mean  annual  temperature 47°  F. 

There  are  six  or  eight  very  weak  thermal  springs,  having  the  same  chemical  com- 
position, but  varying  m  temperature  from  95°  to  118°  F.  In  16  ounces  of  water  there 
are  only  2.08  grs.  of  solids,  sulphate  of  soda  being  the  chief  (1.51).  The  waters,  after 
cooling  to  about  90°,  are  used  as  baths,  and  are  said  to  stimulate  the  nervous  system. 
It  seems  certain  that  the  prematurely  old,  the  hypochondriac,  the  paralytic,  and  the 
sufferer  from  chronic  rheumatism  derive  benefit. 

The  waters  of  Teplitz,  in  Bohemia,  very  much  resemble  those  of  Gastein,  as  re- 
gards temperature  and  chemical  power.  They  contain  only  about  4.64  grains  of 
solids  in  the  16  oz. ;  the  carbonates  of  soda  and  lime,  with  sulj^hate  of  soda  being  the 
chief  ingredients.     The  baths  are  used  in  gouty  and  paralytic  affections. 


495.  Friedrichshall,  in  Saxe-Meiningen. 

This  place  has  long  been  noted  for  the  manufacture  of  Glauber's  salts  and  common 
salt.  Of  late  years  the  waters  have  acquired  a  high  reputation,  especially  for  cases 
where  it  is  necessary  to  promote  excretion  from  the  liver,  kidneys,  and  bowels. 

The  bitter  saline  water  of  Friedrichshall  contains  about  194  grs.  of  solids  in  the  16 
ounces,  with  5.32  cubic  inches  of  carbonic  acid  gas.  The  chief  ingredients  are  chlo- 
ride of  sodimn  (61),  sulphate  of  soda  (46),  sulphate  of  'magnesia  (39),  chloride  of  7nag- 
nesium  (30),  sulphate  of  lime  (10),  with  small  proportions  of  sulphate  of  potash,  car- 
bonate of  magnesia,  bromide  of  inagnesiu^n,  carbonate  of  lime,  and  silica. — The  dose  is 
from  three  ounces  to  a  pint  or  a  pint  and  a  half,  according  to  the  aperient  effect 
required. 


496.   Carlsbad,  in  Bohemia. 

This  town  occupies  the  bottom  of  a  narrow  winding  valley,  on  the  banks  of  the 
Topel,  70  miles  W.N.W.  of  Prague.  The  season  extends  from  the  beginning  of 
June  until  the  end  of  September  ;  but  the  month  of  May  is  very  quiet,  pleasant,  and 
healthy.     The  "  cure"  generally  occupies  from  five  to  six  weeks. 

There  are  several  important  springs,  chiefly  differing  from  each  other  only  in  tem- 
perature. The  most  important  is  the  Sprudel  ;  the  waters  of  which  bound  upwards 
for  four  or  five  feet,  and  then  fall  back  in  foam  while  giving  off  clouds  of  vapor. 
The  temperature  is  about  165"  F.,  and  there  are  some  45  grs.  of  solids  in  the  16  oz. 
The  principal  salts  arc  sulphate  of  soda  (20),  carbonate  of  soda  (9),  chloride  of  sodium 
(8),  and  carbonate  of  lime  (2);  with  small  quantities  of  sulphate  of  potash,  carbonate 
of  iron,  phosphate  of  alunmia,  and  silica.  The  carbonic  acid  gas  is  nearly  8  cubic 
inches. — The  Schlossbrunnen  contain  only  half  the  amount  of  sulphate  of  soda, 
double  the  quantity  of  carbonic  acid  gas,  and  have  a  temperature  of  113".  The  heat 
of  the  waters  of  the  Theresienbrunnen  is  131",  and  as  regards  important  ingre- 
dients may  be  said  to  resemble  the  Schlossbrunnen.  The  Marktbrunnen  differ 
from  the  others  principally  in  containing  a  little  iodide  and  bromide  of  sodium. 

T)ie  waters  are  chiefly  taken  internally,  early  in  the  morning  and  again  in  the 
evening.  The  dose  varies  from  one  or  two  glasses  to  ten  or  twelve ;  according  to  the 
stimulating  and  alterative  effect  on  the  digestive  organs  and  abdominal  viscera  gen- 
erally, which  it  is  desirable  to  produce.  The  cases  most  benefited  are, — liver  and  ab- 
dominal diseases,  diabetes,  gouty  and  rheumatic  disorders,  calculous  afl'ections,  and 
hypochondriasis  with  dyspepsia  and  constipation.  Old  Indians,  with  enlarged  livers, 
often  derive  remarkable  relief.     Baths  of  the  cooled  mineral  water  are  now  but  sel- 


MINEKAL    WATERS.  395 

dom  resorted  to,  though  for  one  hundred  and  fifty  years  invalids  only  visited  Carls- 
bad for  the  purpose  of  butliiiig.  Sometimes  the  jieat  soil  from  tlie  neighborhood, 
mixed  with  Sprudel  water,  is  used  as  a  poultice,  &c. 

497.  Marienhad,  in  Bohemia. 

Maricnhad,  in  tlio  territory  of  the  Abbey  of  Tepl  and  the  district  of  Eger  in  Bo- 
hemia, is  about  five  hours'  drive  from  Carlsbad.  The  air  is  pure  and  dry,  but  changes 
in  temperature  take  ))lace  rajiidly  owing  to  the  height  of  the  village — 1912  feet  above 
the  level  of  the  North  Sea.  The  season  lasts  from  the  commencement  of  May  until 
the  end  of  September. 

There  are  several  cold  (from  43°  to  50®  F.)  saline  chalybeate  springs:  the  chief 
constituent  being  sulphate  of  soda,  with  a  moderate  quantity  of  iron  and  carbonic 
acid.  The  waters  when  drawn  are  quite  clear,  but  as  the  gas  escajies  they  become 
turbid  from  deposition  of  tlie  carbonates.  The  Krkuzbrxtnn  has  G9  grains  of  solids 
in  the  16  oz.,  with  8^  cubic  inches  of  carbonic  acid  gas.  The  principal  salts  are  sul- 
phate of  soda  (38),  chloride  of  sodium  (13),  carbonate  of  soda  (9),  and  carbonate  of  mag- 
nesia (3) ;  with  small  quantities  of  the  carbonates  of  lime,  lithia,  iron,  manganese,  &c. 
The  Fekdinandsbrunn  has  nearly  the  same  solid  ingredients,  but  with  nearly  14  cubic 
inches  of  carbonic  acid  gas.  The  Waldbrunn  is  much  Aveaker  in  sulphate  of  soda 
(7),  and  common  salt  (3),  but  its  proportion  of  carbonic  acidgasis  18f  cubic  inches.  The 
waters  of  these  brunnen  are  all  used  for  drinking.  The  Carolinenbrunn  has  only 
11  grs.  of  solids  in  the  16  oz.,  sulphate  of  soda  being  the  chief;  but  there  are  15^  cu- 
bic inches  of  carbtmlc  acid  gas.  The  Ambrosiusbrunn  is  still  weaker  (7  grs.  in  16 
oz.),  with  13  inches  of  gas;  while  the  Marienbrunn  has  scarcely  any  salts  (2  grs. 
in  16  oz.),  with  9  cubic  inches  of  carbonic  acid  gas.  The  well  of  the  JVlarienbrunn  is 
used  only  for  water  and  gas  baths  ;  but  the  Caroline  and  Ambrosius  waters  are  em- 
ployed internally  and  externally. 

The  etfect  of  the  Marienbad  waters  is  laxative,  alterative,  and  tonic,  in  proportion 
to  the  dose  (from  one  to  six  tumblerfuls) ;  while  they  increase  the  action  of  the  liver 
and  kidneys,  and  promote  appetite.  Hence  they  are  particularly  valuable  in  chronic 
disorders  of  the  abdominal  viscera.  The  mud  baths  and  poultices  are  made  with  the 
Mailenbad  Avater  mixed  with  a  black  mineral  pulverulent  substance,  brought  from  a 
neighboring  peat-bed.  They  stimulate  the  skin,  heal  chronic  ulcers,  and  disperse 
glandular  swellings.  The  gas  baths  (carbonic  acid  with  a  small  amount  of  sulphur- 
etted hydrogen)  soothe  muscular  and  neuralgic  pains,  remove  torpor  of  the  female 
sexual  organs,  and  generally  tranquillize  the  nervous  system. 

The  bitter  saline  waters  of  Ptjllna,  in  Bohemia,  are  very  nauseous  and  indigesti- 
ble, while  they  possess  no  advantages  over  the  ordinary  preparations  sold  by  the 
chemist.  Their  chief  ingredients  are  sulphate  of  soda  (124  grains  in  the  16  oz.),  sul- 
phate of  magnesia  (93),  chloride  of  magnesium  (16),  carbonate  of  magnesia  (6),  with 
sulphates  of  lime  and  j^otash. 

498.  Uger,  in  Bohemia. 

This  frontier  town  stands  on  the  right  bank  of  the  Eger,  92  miles  W.  of  Prague. 
In  the  district,  some  three  miles  oft"  is  the  Spa  of  Fkanzensbad.  The  tonic  solvent 
waters  of  this  spring  have  a  refreshing  acidulous  taste,  a  temperature  of  52"  F.,  with 
42  grs.  of  solids  in  the  16  oz.  The  chief  of  these  are  siclphate  of  soda  (24),  chloride 
of  sodium  (9),  and  carbonate  of  soda  (9) ;  together  with  the  carbonates  of  magnesia, 
lime,  iron,  lithia,  manganese,  and  strontia,  and  40  cubic  inches  of  carbonic  acid  gas. 

The  waters  of  the  Franzensbad  and  other  wells  are  taken  internally  and  employed 
as  baths.  They  strengthen  the  nervous  system,  improve  digestion,  stimulate  the  circu- 
lation, relieve  bronchial  affections,  and  act  powerfully  on  the  uterine  organs.  Mud 
and  gas  baths  are  likewise  employed  ;  the  black  mud  containing  iron,  soda,  lime, 
alumina,  and  ulmic  acid.  They  are  perhaps  beneficial  in  old  rheumatic  atfections, 
gouty  deposits,  and  in  paralysis  without  active  disease  of  the  nervous  centres.  The 
gas  baths  are  considered  as  specifics  for  the  cure  of  scrofulous  ulcers. 


499.  Aix-les- Bains,  in  Savoy. 

This  beautiful  and  sheltered  town,  768  feet  above  the  sea,  may  be  reached  by  railway 
from  Paris  in  about  fifteen  hours.     The  climate  is  mild  but  yet  bracing,  and  is  espe- 


396  APPENDIX    OF   FORMULA. 

cially  adapted  to  invalids  from  April  until  October.  There  are  two  chief  springs ;  but 
as  thev  are  only  slightly  mineralized,  the  eftects  which  they  produce  must  chiefly  be 
due  to  their  temperature, — about  116°  F.  The  Sulphur  Spring  contains  but  little 
more  than  three  grains  of  salts  in  the  sixteen  ounces,  with  a  small  quantity  of  carbonic 
acid  and  sulphuretted  hyd^-ogen  gas.  The  Alum-Spring,  so  called  on  the  lucus  d,  non 
lucendo  principle,  since  it  contains  no  alum  appreciable  to  the  senses,  has  the  same 
composition,  minus  the  sulphuretted  hydrogen. 

The  waters  are  chiefly  used  externally,  and  especially  in  the  form  of  douches.  They 
are  valuable  in  chronic  rheumatism,  sciatica,  rigidity  of  tendons  or  muscles  after 
sprains  and  contusions,  chronic  skin  aflections,  diseases  of  the  bones,  nervous  disor- 
ders, &c. 


500.  Batlis  of  Switzerland. 

Leuk  or  LouECHE,  on  the  Khone,  stands  a  little  to  the  left  of  the  high  road  passing 
through  the  Vallais  to  the  Simplon,  and  is  nearly  501.0  feet  above  the  sea.  There  are 
twenty-three  thermal  mineral  springs,  varj'ing  in  temperature  from  95°  to  124°  F. 
The  latter  is  the  heat  of  the  St.  Laurent  or  Lorenzquelle.  All  the  waters  have  the 
same  composition,  the  solid  constituents  being  about  fifteen  grains  in  the  sixteen 
ounces.  The  chief  salt  is  the  sulphate  of  lime  (nearly  13),  with  small  quantities  of 
the  sulphates  of  magnesia  and  soda,  <fcc.  It  is  the  custom  to  bathe  in  common  ;  there 
being  four  public  piscina,  each  about  a  yard  deep,  and  each  capable  of  accommodating 
some  forty  bathers,  with  their  small  floating  tables.  On  the  first  daj'  the  patient 
remains  an  hour  in  the  water,  clothed  in  a  long  flannel  gown;  the  duration  being 
daily  increased  till  it  extends  to  four  or  five  hours  in  the  morning,  and  for  a  shorter 
period  again  in  the  afternoon.  About  the  twelfth  day,  an  erythematous  rash  called 
the  poicssee  appears  over  the  body,  with  prickling  sensations  of  heat,  and  febrile  symp- 
toms ;  its  disappearance  being  followed  by  desquamation  of  the  cuticle.  The  duration 
of  the  bath  is  then  gradually  diminished  by  half  an  hour  daily,  until  the  cure  is  com- 
plete in  some  twenty-five  or  thirty  days  from  the  commencement.  This  peculiar 
practice  is  recommended  in  cases  of  scrofula,  enlargements  of  the  liver  or  spleen, 
chronic  gout  and  rheumatism,  obstinate  eczema  and  psoriasis,  old  wounds  and  ulcers, 
calculous  affections,  &c.     The  season  is  from  May  until  October. 

Pfafers,  in  the  Canton  of  St.  Gallen  in  the  Orisons,  is  in  a  wild  and  sombre  dell. 
The  thermal  water  is  conducted  down  the  romantic  glen  of  the  Tamina  by  wooden 
tubes,  to  the  hotel  and  bathing-house  at  Kagatz,  in  the  valley  of  the  Rhine.  The 
salts  in  the  waters  are  scarcely  equal  to  three  grains  in  the  sixteen  ounces  ;  the  chief 
being  the  sulphates  of  soda  and  lime,  with  carboiiate  of  lime.  The  temperature  is  nearly 
10d°  F.  The  bath  is  used  twice  a  day,  for  about  an  hour  each  time ;  and  is  useful  in 
calming  nervous  irritability,  and  in  relieving  neuralgia,  hysteria,  &c.  The  waters 
are  also  used  for  drinking, — from  four  to  eight  tumblerfuls.  The  invalid  should  be 
advised  to  reside  at  Kagatz  rather  than  at  Pfafers. 

Tarasp,  on  the  right  shore  of  the  Inn  in  the  Orisons,  has  cold  gaseous  springs, 
somewhat  resembling  those  of  Marienbad.  There  are  numerous  wells,  having  their 
source  in  a  rocky  hollow,  some  4300  feet  above  the  sea.  The  chief  are  the  Grosse 
Quelle  and  the  Kleine  Quelle,  their  composition  being  similar,  and  their  temperature 
45°  F.  Their  salts  (95  grs.  in  the  16  oz.)  consist  of  chloride  of  sodium  (29),  carbonate 
of  soda  (27),  sulphate  of  soda  (16),  and  carbonate  of  lime  (12) ;  with  small  quantities  of 
the  carbonates  of  magnesia  and  (?-on,  iodide  of  sodium,  sidphate  of  potash,  &c.  The  car- 
bonic acid  gas  is  32  cubic  inches.  These  aperient  and  resolvent  waters  are  useful  in 
plethora  of  the  abdominal  viscera,  and  in  incipient  phthisis. 

Baden,  a  few  miles  from  Zurich,  on  the  left  bank  of  the  Limmat,  has  several  ther- 
mal gaseous  springs.  The  temperature  of  the  waters  ranges  from  117°  to  122°  F., 
and  the  salts  are  in  the  proportion  of  thirty-four  grains  to  the  sixteen  ounces.  The 
principal  are,  chloride  of  sodium  (13),  sulphate  of  lime  (10),  smaller  quantities  of  the 
carbonates  of  iitne  and  of  magnesia  and  of  stroniia,  sulphate  of  soda,  and  the  chlorides 
of  potassium  and  magncnum,  &c.  There  are  22  cubic  inches  of  carbonic  acid  gas,  125 
of  nitrogen,  and  an  odor  of  sulphuretted  hydrogen.  The  action  of  these  waters  is  chiefly 
diuretic  and  constipating.  They  are  recommended  in  gouty  and  rheumatic  diseases, 
in  chronic  diarrluea  with  congestion  of  the  bowels,  and  in  incipient  phthisis.  They 
are  used  internally,  and  externally  as  baths  and  douches.  The  climate  of  Baden  being 
mild,  invalids  often  remain  throughout  the  winter. 


MINERAL   WATERS.  397 

BiRMENSDORF  has  hittor  purgative  wntors  rosr mbliHf(  those  of  Pullna.  They  are 
cold  (40*^  F.),  hav(!  only  traces  of  carbonic  acid  <^as,  and  their  solid  constituents 
slightly  exceed  five  grains  in  the  sixteen  ounces.  They  are  used  principally  for  ex- 
portation. 

ScHTNZNACH,  in  the  canton  of  Aargau,  in  a  valley  through  which  flows  the  Aar, 
five  miles  from  Baden,  is  well  known  for  its  saline  sulphurous  thermal  spring.  The 
temperature  of  the  waters  is  about  94"  F.,  the  solid  constituents  being  nearly  twenty- 
five  grains  in  the  sixteen  ounces,  with  1^  cubic  inches  of  carbonic  acid  (fa/i,  and  (5^  of 
sulphuretted  hydrogen.  The  chief  salts  are,  sulfliate  of  .soda  ((ij),  su/p/iate  of  lime  (7), 
and  chloride  of  sodium  (5) ;  with  smaller  quantities  oi  milphdie  of  maynesia,  chloride  of 
7nagnesi,u7n,  and  carbonate  of  lime.  The  invalids  both  drink  and  bathe;  the  baths 
being  used  for  twenty  minutes  at  first,  and  afterwards  for  a  longer  time  if  necessary. 
The  poussSe  is  milder  but  appears  more  quickly  than  at  Leuk.  The  waters  have  a 
reputation  for  relieving  strumous  and  rheumatic  afi'ections,  for  curing  skin  diseases, 
and  for  healing  callous  spongy  ulcers.  The  season  lasts  from  the  middle  of  May  to  the 
end  of  September. 


Septembku,  18tO. 

C^TA.LOGXJE 

OF 

WORKS  ON  MEDICL\E,  SURGERY,  DENTISTRY, 
AND  THE  COLLATERAL  SCIENCES. 

PUBT.ISHET3    BY 

LINDSAY  &  BLAKISTON,  PHILADELPHIA. 

C  C)  N  T  E  N  T  S. 

Lindsay  &  Blakiston's  Vistttng  List  for  1871,  see  reduction  in  prices. 

Tanner's  Practice  op  Medicine,  5th  American  Edition  (Just  Ready.) 
Reprinted  from  the  6th  Enlartred  and  Improved  London  Edition. 

Meigs  and  Pepper's  Practical  Treatise  on  Diseases  of  Children,  the 
Fourth  Edition,  very  much  enlarGred. 

Cazeaux's  Great  Work  on  Obstetrics,  the  most  complete  Text-Book 
on  the  subject  now  published. 

Aitken's  Practice,  from  the  5th  enlarged  London  Edition,  with  additions 
by  Dr.  Clymer  equal  to  500  pages  of  the  English  copy,  made  with 
special  reference  to  the  wants  of  the  American  Practitioner. 

Trousseau's  Clinical  Medicine,  3  volumes  (the  third  volume  just  ready.) 
Price  reduced. 

Works  by  Lionel  S.  Beale,  F.R.S.,  Prices  reduced. 

New  Books  Just  Ready  and  in  Preparation. 

Alphabetical  List  of  Lindsay  &  Blakiston's  Medical  Publications,  with 
brief  Critical  or  Descriptive  Notices. 

Dental  Works  published  by  Lindsay  &  Blakiston. 

Scientific  Books       do.  do.  do. 

The  New  Sydenham  Society's  Publications,  a  Revised  List,  with  an- 
nouncements for  1810. 

American  and  British  Periodicals  supplied  by  Lindsay  &  Blakiston. 

Anatomical  Maps  and  Plates. 

English  Books  Recently  Imported. 

Condensed  List  op  Lindsay  &  Blakiston's  Publications. 

LINDSAY  &  BLAKISTON,  in  issuing  a  revised  Catalogue  of  their  Medical 
Piililications,  desire  to  call  the  attention  of  the  Profession  to  the  reduction  they  have 
made  in  the  price  of  their  Visiting  List  for  1871.  This  little  work  having  become 
an  almost  indispensable  companion  to  the  Practising  Physician,  they  wish  to  extend 
as  far  as  possible  its  usefulness  by  keeping  the  price  down  as  low  as  the  increased  cost 
of  manufacture  will  permit.  They  have  also,  in  order  to  meet  to  some  extent  the 
demand  for  lower  prices,  reduced  the  price  of  Dr.  Beale's  books  of  Trousseau's 
Clinical  Medicine,  the  3d  volume  of  which  has  just  been  issued,  and  of  many  other 
books  in  their  Catalogue,  and  also  their  rates  for  the  importation  of  Foreign  Books 
and  Periodicals. 

gf^°*  Orders  for  any  Medical  Books,  whether  published  in  the  United  States  or 
otherwise,  and  not  contained  in  this  Catalogue,  will  be  executed  promptly,  and  at  the 
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PRICES  REDUCED  OF 

Lindsay  &  Blakiston's 

PHYSICIAN'S  VISITING  LIST. 

NOW  READY  FOR  1871. 

"The  simplest  of  all  the  visiting  lists  published,  it  must  continue  to  hold,  what  it 
now  has,  the  preference  over  all  other  forms  of  this  indispensable  companion  for  the 
Physician." — New  York  Med.  Journal. 

oonsTTEiNrTS. 


1.  Table  of  Signs,  or  Guide  for  Registering  Visits,  En- 

g-agemente,  &c. 

2.  An  Alnijxnac  for  1868. 

3.  Mar!?hall  Hall's  Ready  Method  in  Asphyxia. 

4.  Poisons  and  their  Antidotes. 

5.  Table  for  Calculating  the  Period  of  TJtero-Oestation. 

6.  The  Visiting  List  arranged  for  25,  60,  75,  or  100 

Patients. 


7.  Memoranda  pages  for  every  month  in  the  year. 

8.  Pages  for  Addresses  of  Patients,  kc. 

9.  "        Bills  and  Accounts   asked  for  and    de- 

livered. 

10.  "        Obstetric  Engagements. 

11.  "        Vaccination. 

12.  "        Recording  Obstetric  Cases,  Deaths,  and 

for  General  Memoranda. 


SIZES   AND    PRICE. 

For  25  Patients  weekly.     Tucks,  pockets,  and  pencil, 

60      "  "  "  "  "     .         . 


75 
100 

50 
100 


<,o     1      r  Jan.  to  June.  ) 

' '  2  vols .  -    T  1     *     r»  > 

{  July  to  Dec.    j 

,,„     ,      (  Jan    to  June.  "1 

"2  vols,  s  T   1     *    T^  r 

\  July  to  Dec.     J 


$1 

00 

1 

25 

1 

50 

2 

00 

2 

50 

3 

00 

Also,  AN  INTERLEAVED  EE>ITION, 

for  the  use  of  Country  rhi/sician.<i  and  others  who  compound  their  own  Prescriptions, 
or  furnish  Medicines  to  their  patients.  The  additional  pages  can  also  be  used  for  Special 
Memonmda,  recording  important  cases,  &c.,  &c. 

For  25  Patients  weekly,  interleaved,   tucks,  pockets    etc.,         .         .         .         .    Si  50 
60       "  "  "  "         "  "  .         .  ■      .         .       1  75 

50        "  "     2  vols  I  Jan.  to  June.  I    ,,  ..  ....     3  00 

1^  July  to  Dec.    j 

This  Visiting  List  has  now  been  published  for  Twenty  Years,  and  has 
met  with  such  uniform  and  hearty  approval  from  the  Profession,  that  the 
demand  for  it  has  steadily  increased  from  year  to  year. 

The  Publi.'^hers,  in  order  to  still  further  extend  its  circulation  and  useful- 
ness, and  to  keep  up  the  reputation  which  it  has  so  long  retained,  of  being 

THE  CHEAPEST  AND  BEST, 

as  well  as  the  Oldest  Visiting  List  published,  have  now  made  a  very 
considerable  reduction  in  the  price. 

It  can  be  procured  from  the  principal  booksellers  in  any  of  the  larr/p. 
cities  of  the  United  States  and  Canada,  or  copies  will  be  forwarded  l)y  mail, 
free  of  postage,  by  the  Pul)lishers,  upon  receipt  by  them  of  the  retail  price 
as  annexed. 

In  ordering  the  work  from  other  booksellers,  order 

IJndsay  ^  BlnL'tsfon/s  Ph(/slcian*s  Vis  it  fur/  List. 

And  in  all  cases,  whether  ordering  from  the  Publishers  or  otherwise, 
specify  the  size,  style,  &c.,  wanted. 

LINDSAY  &  B.LAKISTON,  Publishers, 

2'"*  Sotffh  Si.rt/i  St.,  P/i  iff!  fief  phi  a. 


"T/ie  leading  feature  of  this  hook  is  its  essentially  practical  character.^'— 

London  Lancet. 

Tanner's  Practice  of  Medicine. 

FIFTH  AMERICAN,   FROM  THE   SIXTH  LONDON  EDITION. 

ENLARGED  AND  THOROUGHLY  REVISED, 

JUST    READY. 

THE  PRACTICE  OF  MEDICINE,  hj  Thomas  Hawkes  Tanner, 
M.D.,  Felloiv  of  the  Royal  College  of  Physicians,  Author  of  Tanner's 
Practical  Treatise  on  the  Diseases  of  Children,  &c.,  &c.  Ffth  Ame- 
rican Edition,  with  a  very  large  Collection  of  Formulae.  One  Volume, 
Boyal  Octavo,  containing  over  1100  pages. 

Price,  handsomely  bound  in  Cloth,         .         .         $6  00 
"  "  "  Leather,     .         .  7  00 


OOISTTEH^TS. 


Part  1 


General  Diseases, 

2.  Fevers. 

3.  Venereal  Diseases. 

4.  Diseases  of  the  Nervous  System. 

5.  Diseases  of  the  Organs  of  Respi- 

ration and  Circulation. 

6.  Diseases  of  the  Thoracic  Walls. 

7.  Diseases  of  the  Alimentary  Canal. 

8.  Diseases  of  the  Liver. 

9.  Diseases    of    the    Pancreas    and 

Spleen. 


Part  10.  Diseases  of  the  Abdominal  Walls. 
"     11.   Diseases  of  the  Urinary  Organs. 
"     12.   Diseases  of  tlie  Uterine  Organs. 
"     13.   Diseases  of  the  Skin. 
"    14.  Diseases    of  Cutaneous    Append- 
ages. 
"     15.   Diseases  of  the  Bloodvessels. 
"    16.  Diseases  of  the  Absorbent  System. 

Appendix  of  Formulae 

General  Index. 


"The  rapidity  with  which  edition  after  edition  of  this  work  has  appeared  and  dis- 
appeared is,  on  the  whole,  a  true  test  of  its  merits.  The  fifth  edition  was,  we  believe, 
a  very  large  one,  yet  the  book  was  for  some  time  out  of  print  before  the  present  one 
could  be  prepared.  Dr.  Tanner  has  chosen  his  title  well;  his  work  is  essentially  one 
on  the  practice  of  medicine  in  its  widest  sense,  and  it  is  in  what  relates  to  pure  prac- 
tice, as  contradistinguished  from  the  theory  of  medicine,  that  the  book  is  strongest; 
for  it  has  been  the  author's  aim  to  collect  everything  he  could  think  of  which  would 
aid  the  practitioner  in  the  discharge  of  his  duties.  But  it  is  not  to  men  engaged  in 
the  active  discharge  of  the  duties  of  their  profession  alone  to  whom  the  book  is  wel- 
come. With  the  student,  preparing  himself  to  enter  upon  these  duties,  the  book  has 
long  been  a  favorite,  chieily,  we  believe,  from  the  lucidity  of  its  style  and  the  character 
of  its  substance.  Other  books  there  are,  more  eloquent  and  more  recondite,  but  none 
excel  Dr.  Tanner's  work  in  these  important  features.  All  that  is  necessary  to  know 
is  here,  disposed  in  such  a  manner  as  to  admit  of  the  readiest  reference,  and  of  being 
most  easily  retained  in  the  memory.  Our  limits  will  not  admit  of  an  extended  review, 
which  would  be  out  of  place  with  regard  to  a  book  practically  established  as  a  standard. 
It  carries  its  own  recommendation,  and  is  its  own  best  passport  to  general  use.  It  has 
been  the  result  of  very  great  labor  —  labor  well  spent;  and  it  appears  in  a  form  which 
is  creditable  to  its  publishers  as  it  is  pleasing  to  those  who  have  to  use  the  book. — 
British  and  Foreign  Medico- Ofiirurgical  Review,  April,  1870. 

"Dr.  Tanner's  works  are  all  essentially  and  thoroughly  practical, —  he  never  for  one 
moment  allows  this  utilitarian  end  to  escape  his  mental  view.  He  aims  at  teaching  how 
to  recognize  and  how  to  cure  disease,  and  in  this  he  is  thoroughly  successful.  It  is 
indeed  a  wonderful  mine  of  knowledge."  —  Medical  Times  and  Gazelle,  Jaly,  1SG9. 


MEIGS  AND  PEPPER  ON  CHILDREN. 

"  The  most  thorough  and  Practical  Work  on  the  subject  now  before  the 

Profession.^' 

Meigs  and  Pepper's    Practical  Treatise    on 
the  Diseases  of  Children. 

Pourth  Edition,  thoroughly  Eevised  and  greatly  Enlarged. 

By  J.  Forsyth  Meigs,  M.  D.,  Felloio  of  the  College  of  Physicians  of 

Philadelphia,  &c.,  &c.,  and  William  Pepper,  M.  D.,  Physician  to  iht 

Philadelphia  Hospital,  &c.,  &c.,  forming  a  Royal  Octavo  Yolume  of 

over  900  pages.     Price,  bound  in  Cloth,         .  .  .         $6  00 

Leather,       .  .  .  .  7  00 

Dr.  Jleigfi'  work  has  been  out  of  print  for  some  ye.irs.  The  r.apid  sale  of  the  three 
previous  editions,  and  the  great  demand  for  a  new  edition,  is  suiEcient  evidence  of  its 
great  popularity;  while  the  vei-y  large  practice  of  many  years'  standing  of  the  author 
in  the  speciality  of  "  Diseases  of  Children,"'  imparts  to  it  a  value  unequalled,  probably, 
by  any  other  work  on  the  same  subject  now  before  the  Profession.  This  present  edition 
has  been  almost  entirely  rewritten  and  rearranged,  and  no  effort  or  labor  has  been 
spared  by  either  Drs.  Meigs  or  Pepper,  to  make  it  represent  fully  in  its  most  advanced 
state  the  present  condition  of  Medicine  as  applied  to  Children's  Diseases. 

The  entire  work  has  been  subjected  to  careful  revision.  Several  of  the  articles,  as 
those  on  Eclampsia,  Chorea,  and  Parasitic  Skin  Diseases,  have  been  much  enlarged; 
and  others,  as  the  various  articles  on  the  Diseases  of  the  Stomach  and  Intestines,  and 
f.hat  on  Eczematous  Atfections,  entirely  rewritten.  In  addition,  articles  have  been 
ttdded  upon  the  following  important  subjects: 

Diseases  of  the  Heart.  Facial  Paralysis. 

Cyanosis.  Rheumatism. 

Diseases  of  the  Cfficum  and  Appendix.  Diphtheria. 

Intussusception.  Mumps. 

Chronic  Hydrocephalus.  Kickets. 

Tetanus  Nascentium.  Tuberculosis. 

Atrophic  Infantile  Paralysis,  Infantile  Syphilis. 

Progressive  Paralysis,  with  apparent  Hy-  Typhoid  Fever, 

pertrophy  of  the  Muscles.  Sclerema. 

The  new  matter  thus  added  amounts  to  nearly  200  pages.  It  has  been  the  effort  of 
the  authors,  while  endeavoring  to  make  the  work  fully  represent  the  state  of  our  knowl- 
edge upon  the  subjects  treated  of,  to  retain  its  eminently  practical  character;  and  with 
this  view,  an  unusually  large  amount  of  space  has  been  devoted  to  the  consideration 
of  the  treatment  of  each  disease. 

"This  is  the  fourth  edition  of  ]Meigs  on  Diseases  of  Children,  greatly  enlarged  and 
improved  by  chapters  upon  a  large  number  of  new  subjects,  and  also  by  a  very  copious 
index,  which  facilitates  reference,  and  makes  the  work  more  serviceable  to  the  Prac- 
titioner. As  now  enlarged,  it  is  one  of  the  most  complete  and  comprehensive  works  of 
its  class,  and  will  meet  the  wants  of  the  Profession  in  this  department  most  admirably." 
—  Buffalo  Med.  and  Surg.  Journal. 

"It  is  very  comprehensive,  and  embraces  most  of  the  maladies  incident  to  childhood 
and  infancy.  We  consider  it  a  very  safe,  reliable,  and  suggestive  guide,  being  quite  large 
and  full  in  detail,  embracing  almost  everything  pertaining  to  the  subject,  making  it  a 
very  useful  book  both  for  reference  and  stu<ly." — Medical  Archives. 

"It  forms  the  most  complete  and  comprehensive  work  upon  the  diseases  of  children 
published  in  this  country.  It  has  for  years  been  one  of  the  standard  authorities,  and 
in  its  present  enlarged  form  will  still  more  command  attention.  It  presents  the  latest 
views  of  pathology  and  treatment,  and  tak^s  into  consideration  many  subjects  which 
were  entirely  omitted  in  the  previous  editions.'' — Detroit  Journal  of  Medicine,  S^c. 

"It  is  satisfactory  to  note  that  tiie  authors  have  brought  up  their  work  to  the  level 
«f  the  pathological  knowledge  of  the  day,  and  that  their  therapeutical  notions  are 
equally  advanced.  The  authors  are  enrolled  among  the  more  enlightened  tlicrapeut- 
ists  of  our  time.  One  cannot  fail  to  be  struck  thro&ghout  the  treatise  with  the  very 
judicious  advice  given  by  the  authors  on  various  points  of  treatment.  The  work,  as  a 
whole,  is  entitled  to  rank  with  the  best." — Medical  Repertory 


Cazeaux's  Great  Work  on  Obstetrics. 

THE  MOST  COMPLETE  TEXT-BOOK  NOW  PUBLISHED. 
GliEATLY    ENLARQED    ANO    IMPROVED. 

CONTAINING   175    ILLUSTRATIONS. 

A  Theoretical  and  Pmctical  Treatise  on  Midwifery,  including  the  Diseuse>> 
of  Pregnancy  and  Parturition,  by  P.  Cazeatjx,  Member  of  the  ImpeHai 
Academy  of  Medicine ;  Adjunct  Professor  in  the  Faculty  of  Medicine  of 
Par-is,  etc.,  etc.  Revised  and  Annotated  by  S.  Tarnter,  Adjunct  Pro- 
fessor in  the  Faciil:y  of  Medicine  of  Paris  ;  Former  Clinical  Chief  of  the 
Lying-in- Hospital,  c'c,  etc.  Fifth  American  from  the  Seventh  French  Edi- 
tion. Translated  />»/ \Vm.  R.  Bullock,  M.  D.  In  one  volume  Royal  Oc- 
tavo, of  over  1100  pages,  with  numerous  Lithographic  and  other  Illastra- 
tious  on  Wood. 

Price,  bound  in  Cloth,  bevelled  boards, $6.50 

"  "         Leather, 7.50 

M.  Cazeaux's  Great  V/ork  on  Obstetrics  has  become  classical  in  its  character,  and 
almost  an  Encyclopagdia  in  its  fulness.  Written  eipresslj  for  the  use  of  students  of 
medicine,  and  those  of  midwifery  especially,  its  teachings  are  plain  and  explicit,  preseHt- 
ing  a  condensed  summary  of  the  leading  principles  established  by  the  masters  of  the 
obstetric  art,  and  such  clear,  practical  directions  for  the  management  of  the  pregnant, 
parturient,  and  puerperal  states,  as  have  been  sanctioned  by  the  most  authoritative 
practitioners,  and  confirmed  by  the  author's  own  experience.  Collecting  his  materials 
from  the  writings  of  the  entire  body  of  antecedent  writers,  carefully  testing  their  correct- 
ness and  value  by  his  own  daily  experience,  and  rejecting  all  such  as  were  falsified  by 
the  numerous  cases  brought  under  his  own  immediate  observation,  he  has  formed  out  of 
them  a  body  of  doctrine,  and  a  system  of  practical  rules,  which  he  illustrates  and  eni-brces 
in  the  clearest  and  most  simple  manner  possible. 

OPINIONS  OF  THE  PRESS. 

"Itisunqtiestionably  a  work  of  the  highest  oxcellcuce,  rich  in  information,  and  perhaps  fuller  in  details 
than  any  text-book  with  which  we  are  acquainted.  The  author  has  not  merely  treated  of  every  qaes- 
tion  which  relates  to  the  business  of  parturition,  but  ho  has  done  bo  with  judgment  and  ability." 
British  and  Foreign  Medico-Cliirurgical  lievieiv. 

"  The  translation  of  Dr.  Bullock  is  remarkably  well  done.  AVe  can  recommend  this  work  to  those 
egpecially  interested  in  the  subjects  treated,  and  can  especially  recommend  the  American  edition." 
Medical  Times  and  Gazette. 

"  The  edition  before  us  is  one  of  unquestionable  exoellence.  Every  portion  of  it  has  undergone  a 
thorough  revision,  and  no  little  modification  ;  while  co{)ious  and  important  additions  have  been  made  to 
nearly  every  part  of  it.  It  is  well  and  beautifully  illustrated  by  numerous  wood  and  lithographic 
engravings,  and,  in  tjpographical  execution,  will  bear  a  favorable  comparison  with  other  works  of  the 
same  class." — American  Medical  Journal. 

"In  the  multitudinous  collection  of  works  devoted  to  the  propagation  of  human  beings,  and  to  tho 
details  of  parturition,  none,  in  our  estimatioo,  bears  nny  comparison  to  the  work  of  Cazeaux,  in  its 
entire  perfcctness ;  and  if  wo  were  called  upon  to  rely  alone  on  one  work  on  accouehments,  our  choice 
would  fall  ujjon  the  book  before  us  without  any  kind  of  hesitation." — West.  Jour,  of  Med.  and  Sin-oarii. 

"Wo  do  not  hesitate  to  say,  that  it  is  now  the  most  comjilctc  and  best  treatise  on  the  subiect  in  the 
English  language." — Buffalo  Medical  Journal. 

"We  know  of  no  work  on  this  all-important  branch  of  our  profession  that  we  can  recommend  to  the 
itudent  or  practitioner  as  a  safe  guide  before  this." — Cliicac/o  Medical  Journal. 

"Among  the  many  valuable  treatises  on  the  science  and  art  of  obstetrics,  the  work  of  Cazeaux  stands 
pre-eminent." — St.  Louis  Med.  and  Sur(j.  Journal. 

"  M.  Cazeaux's  book  is  the  most  complete  we  have  ever  seen  upon  the  subject.  It  is  well  translated^ 
«cd  reflects  great  credit  upon  D-.  Bullock's  intelHgcnce  and  industry." — N.  A.  Medico-Cliinirg.  Review. 


"  The  Representative  Booh  of  Medical  Science.^''  —  London  Lancet. 

Aitken's  Science  and  Practice  of  Medicine. 

SECOND  AMERICAN  PEOM  THE  PIPTH  LONDON  EDITION. 

Coiitaining  Additions  equal  to  500  pages  of  the  English  Edition,  prepared  by 

the  American  Editor  with  Special  Reference  to  the 

wants  of  the  American  Practitioner. 

The  Science  and  Practice  of  Medicine.  By  William  Aitken,  M.D.  Second 
American  from  the  Fifth  Enlarged  London  Edition,  icith  Additions  bij 
Meredith  Clymer,  M.D.,  late  Professor  of  the  Institutes  and  Practice  of 
Medicine  in  the  University  of  Neio  York,  Physician  to  the  Philadelphia 
Hospital,  etc.     In  2  Volumes  Royal  Octavo. 

With  a  COLORED  MAP.  a  LITHOGRAPHIC  PLATE,  and  ONE  HUNDRED  AND 
THIRTY  ILLUSTRATIONS  ON  WOOD. 

Price,  bound  in  Cloth,  bevelled  boards  ....         $12.00 

Leather,     ....  ...       14.00 

Fii'teen  months  have  been  spent  bj  Dr.  Aitke.n  in  thoroughly  revising  this  Great  Work, 
and  adding  to  it  many  valuable  additions  and  improvements  amounting  to  about  100 
pages  of  new  matter,  included  in  which  will  be  found  the  adoption  and  incorporation  in 
the  text  of  the  "  new  nomenclature  of  the  Royal  College  of  Physicians  of  LondoJi;  "  to 
which  are  added  the  Definitions  and  the  Foreign  equivalents  for  thnir  English  names. 

The  subjects  of  Malignant  Cholera,  of  Paralysis,  of  Epidemic  Cerebro- Spinal  Menin- 
gitis, and  of  Intestinal  Obstruction  have  been  entirely  ro-written  ;  and  several  other  sub- 
ject* in  connection  with  the  treatment  of  disease,  of  the  greatest  importance,  are  con- 
sidered for  the  first  time  in  this  edition. 

The  Press  have  referred  to  former  editions  of  this  work  as  "  an  admirable  compila- 
tion." "The  most  comprehensive  of  any  in  the  practice  of  medicine."  "It  embodies 
the  most  advanced  knowledge  of  the  time."  "  The  most  valuable  class-book  for  students 
yet  published."  "  It  may  be  looked  upon  as  the  standard  text-book  in  the  English  lan- 
guage." "  The  present  work  contains  information  that  will  not  be  found  in  any  other 
Mitnual  of  Medicine,"  ic,  &c. 

The  author  in  this  edition  has  endeavored  to  keep  up  this  high  reputation,  and  to 
make  it  in  every  respect  a  Representative  Book  of  Medical  Science  and  the  Practice  of  the 
day,  as  understood  and  followed  by  the  best  men  of  the  Profession. 

Large  additions  have  also  been  made  by  the  American  Editor,  Dr.  Meridith  Clymer, 
equal  to  over  500  pages  of  the  London  edition,  and  with  particular  reference  to  the  wants 
of  the  American  Pr.\ctitio.\er,  included  in  which  are  new  articles  upon  the  following 
subjects:  Spinal  Symptoms  of  Typhoid  Fever,  Typho-Malarial  Fever,  Chronic 
Gomp  Dysentery,  Cholera  Morbus,  Cholera  Infantum,  Hereditary  Syjihilis,  Gon- 
orrhceal  Rheumatism,  The  Delirium  of  Inanition,  Chronic  Alcoholism,  Syphilitic 
Disease  of  the  Liver,  Epileptiform  Neuralgia,  Capillary  Bronchitis,  lUasttc 
Broyichitis,  Dilatation  of  the  Bronchia,  Fibroid  Degeneration  of  the  Lung, 
Chro/iic  Pyaeviia,  &c.  rfc. 


Trousseau's  Clinical  Lectures. 

VOL.   III.   NOW  READY. 

Lectures  on  Clinical  Medicine,  delivered  at  the  Eolel-dieu,  Paris.     By 

A.  Trousseau,  Professor  of  Clinical  Medicine  in  the  Faculty  of  Medi' 

cine,  Paris,  &c.,  dec. 

Trousseau's  Lectures  on  Clinical  Medicine,  so  favorably  receivefl,  as  well  by  the 
profesi^ion  of  the  United  States  as  abroad,  are  published  in  this  country  in  connection 
with  the  New  Sydenham  Society,  under  whose  auspices  the  translation  of  Vols.  II.  and 
III.  have  been  made.  Either  of  these  volumes  can  be  furnished  separately,  and  in  order 
to  still  further  extend  the  circulation  of  so  valuable  a  work,  the  Publishers  have  now 
reduced  the  price  to  Five  Dollars  per  volume. 

CoxTEXTS  OF  Volume  I.  —  Tramlaled  and  Edited  by  P.  Victor  Bazire,  M.  D.,  ^c. — 
Lkctcre  1.  On  Venesection  in  Cerebral  Haemorrhage  and  Apoplexy.  2.  On  Apoplec- 
tiform Cerebral  Congestion,  and  its  Relations  to  Epilepsy  and  Eclampsia.  3.  On 
Epilepsy.  4.  On  Epileptiform  Neuralgia.  5.  On  Glosso-laryugeal  Paralysis.  6.  Pro- 
gressive Locomotor  Ataxy.  7.  On  Aphasia.  8.  Progressive  Muscular  Atrophy.  9. 
Facial  Paralysis,  or  Bell's  Paralysis.  10.  Cross-paralysis,  or  Alternate  Hemiplegia. 
11.  Infantile  Convulsions.  12.  Eclampsia  of  Pregnant  and  Parturient  Women.  13. 
On  Tetany.  14.  On  Chorea.  15.  Senile  Trembling  and  Paralysis  Agitans.  10.  Ce- 
rebral Fever.  17.  On  Neuralgia.  18.  Cerebral  Kheumatism.  I'J.  Exophthalmic 
Goitre,  or  Graves'  Disease.     20.  Angina  Pectoris.     21.  Asthma.     22.  Hooping  Cough. 

23.  On  Hydrophobia. 

Contents  of  Volume  II. — Translated  from  the  Edition  of  1868  {being  the  last  revised 
and  enlarged  edition),  by  John  Rose  Cormack,  M.  D.,  Edin.,  F.R.S.E ,  ^c.  — Lecture  1. 
Small-pox.  2.  Variolous  Inoculation.  3.  Cow-pox.  4.  Chicken-pox.  5.  Scarlatina. 
6.  Measles,  and  in  particular  its  unfavorable  Symptoms  and  Complications.  7.  Rubeola. 
8.  Erythema  Nodosum.  9.  Erythema  Papulatum.  10.  Erysipelas,  aud  in  particular 
Erysipelas  of  t-lie  Face.  11.  Mumps.  12.  Urticaria.  13.  Zona,  or  Herpes  Zoster. 
14.  Sudoral  Exanthemata.  15.  Dothinenteria,  or  Typhoid  Fever.  10.  Typhus.  17. 
Membranous  Sore  Throat,  and  in  particular  Herpes  of  the  Pharynx.  18.  Gangrenous 
Sore  Throat.     19.  Intiammatory  Sore  Throat.     20.  Diphtheria.     21.   Thrush. 

Contents  of  Volume  III. — Translated  from  the  Edition  0/I868,  by  John  Rose  Cormack, 
M.D.,  Edin,,  F.R.S.E.,  Sfc. — Lecture  22.  Specific  Element  in  Disease.     23.  Contagion. 

24.  Ozaena.  25.  Stridulous  Lai-yngitis,  or  False  Croup.  2G  (Edema  of  the  Larynx. 
27.  Aphonia:  Cauterization  of  the  Larynx.  28.  Dilatation  of  the  Bronchi  and  Bron- 
chorrhoea.  29.  Hemoptysis.  30.  Pulmonary  Phthisis.  31.  Gangrene  of  the  -Lung. 
32.  Pleurisy;  Paracentesis  of  the  Chest.  33.  Traumatic  Effusion  of  Blood  into  the 
Pleura:  Paracentesis  of  the  Chest.  34.  Hydatids  of  the  Lung.  35.  Pulmonary 
Abscesses  and  Peripneumonic  Vomicoe.  36.  Treatment  of  Pneumonia.  37.  Paracen- 
tesis of  the  Pericardium.  38.  Organic  Affections  of  the  Heart.  52.  Alcoholism.  G2. 
Spermatorrhoea.  C3.  Nocturnal  Incontinence  of  Urine.  64.  Glucosuria:  Saccharine 
Diabetes.      65.   Polydipsia.      67.   Vertigo  a  Stumacho  Lieso. 

3  Volumes  Octav'o,  handsomely  bound  in  Cloth,  Price  $5  GO  each. 

OPINIONS  OF  THE  PRESS. 

"Trousseau  furnishes  us  with  an  example  of  the  best  kind  of  Clinical  teaching.  It  is 
a  book  that  deserves  to  be  popularized.  The  translation  is  perfect."  —  Medical  Times 
und  Gazette. 

"The  great  reputation  of  Prof.  Trousseau  as  a  practitioner  and  teacher  of  Medicine 
in  all  its  branches,  renders  the  present  appearance  of  his  Clinical  Lectures  particularly 
welcome."  —  Medical  Press  and  Circular. 

"The  publication  of  Trousseau's  Lectures  will  furnish  us  with  one  of  the  very  best 
practical  treatises  on  disease  as  seen  at  the  bedside."  —  British  and  Foreign  Medico- 
Chirurgical  Review. 

"A  clever  translation  of  Prof.  Trousseau's  admirable  and  exhaustive  work,  the  best 
book  of  reference  upon  the  Practice  of  Medicine." — Indian  Medical  Gazette. 

"The  Lectures  of  Trousseau,  in  attractiveness  of  manner  and  richness  of  thoroughly 
practical  matter,  worthily  takes  a  place  beside  the  classical  lectures  of  Watson  and 
Graves."  —  British  Medical  Journal. 

"Trousseau  is  essentially  the  French  Graves,  and  his  lectures  should  sooner  than 
this  have  been  translated  into  English."  —  Lancet. 


WORKS  BY  DR.  LIONELS.  BEALE,  F.R.S., 

Professor  of  Physiolojg  and  of  General  and  Morbid  Anatomy  in  King's 
College,  London,  &c.,  &c. 

PRICES     REDUCED. 

Beale's  How  to  Work  with  the  Microscope. 

Seventh  Thousand — 400  Illustkations,  some  of  which  are  Colored, 
together  tvilh  a  Photographic  Frontispiece. 

This  work  is'a  complete  manual  of  microscopical  manipulation,  and  contains  a  full 
description  of  many  new  processes  of  investigation,  with  directions  for  examining 
objects  under  the  highest  powers,  and  for  taking  photographs.  It  is  got  up,  both 
plates  and  letter-press,  in  an  elegant  manner,  and  is,  without  doubt,  the  most  complete 
and  beautiful  book  of  the  kind  in  the  English  language. 

Octavo,  cloth.     Price,  $t  50 

On  Kidney  Diseases,  Urinary  Deposits,  and 

CALCULOUS  DISORDERS.  Lwluding  the  Symjyioms,  Diagnosis, 
and  Treatment  of  Urinarnj  Diseases.  With  full  Directions  for  the 
Chemical  and  Microscopical  Analysis  of  the  Urine  in  Health  and 
Disease.     The  Third  Edition,  very  much  enlarged. 

This  "Work  is.  Illustrated  with  70  Plates,  containing  upwards  of  400  separate 
figures,  all  of  which  have  been  copied  from  Nature,  and  many  are  now  published 
for  the  first  time. 

A  handsome  volume  Octavo.     Bevelled,  cloth.     Price,     .         .     $10  00 

The  complete  and  thoroughly  practical  character  of  this  work  may  be  judged  of  by 
the  fact  that  it  contains  as  manj  .*s  thirty-six  figures  of  different  forms  of  Uric  Acid 
alone. — Tlie  test  and  plates  have  been  printed  on  toned  paper,  with  the  utmost  care, 
and  the  work  is  the  most  complete,  as  well  as  the  largest,  ever  published  on  the  subject. 

Beale  on  tlie  Microscope  in  Practical  Medicine 

FIVE  HUNDRED  ILLUSTRATIONS. 

Tlie  Microscope  in  its  Application  to  Practical  Medicine;  by  Lionel  S. 
Beale,  M.D.,  F.K.S.,  &c.  The  Fourth  Thousand,  thoroughly  Revised 
by  the  Author,  with  nearly  100  pages  of  New  Matter  and  numerous 
additional  Illustrations.     In  One  Volume  Octavo.     Price,  .         $7  00 

Beale's  Protoplasm ; 

Or,  Life,  flatter,  and  Mind.  Second  Edition,  much  Enlarged,  with 
Eight  Colored  Illustrations ;  and  an  entirely  new  section  on  Mind. 
By  Lionel  S.  Beale,  M.D.,  F.R.S  ,  and  Author  of  ''How  to  Work  the 
^Horoscope,'''  "The  Microscope  in  Practical  3Iedicine,''  &c.,  &c.  In 
One  Volume.     Price,  .......         $3  00 

Beale  on  Diseased  Germs, 

Their  Supposed  Nalure.  With  Colored  Plates;,  uniform  %vith  "  Proto- 
plasm."    In  One  Volume  12mo.     Cloth.     Price,  .         .         SI  75 


Altliaus's  Medical  Electricity. 

A  NEW  AND  VERY  MUCH  ENLARGED  EDITION. 

A  Treatiae  on  Medical  Electricity,  Theoretical  and  Practical,  and  its 
Use  in  the  Treatment  of  Paralysis,  Neuralgia,  and  other  Diseases. 
The  Second  Edition,  revised,  and  for  the  most  part  re-writteu.  By 
Julius  Althaus,  M.l).,  Member  of  the  Royal  College  of  Physicians, 
Senior  Physician  to  the  Infirmary  for  Epilepsy  and  Paralysis,  &c.,  &c. 
In  one  volume,  octavo.  Illustrated  by  a  Lithographic  Plate  and  sixty- 
two  Engravings  on  AVood.     Price, $5  00 

It  is  with  gi-eat  pleasure  that  we  welcome,  and  cordially  reconirnend.  Dr.  Altliaus's 
treati.se,  in  the  improved  gui.se  of  a  Second  Edition.  Dr.  Althaus's  work  possesses  the 
merit  of  being  clearly  and  agreeably  written,  while  its  teaching  is  in  accord  with  the 
most  recent  information  ;  and  the  balance  is  evenly  held  between  the  relative  virtues 
of  galvanization  and  faradization — a  point  of  the  highest  importance  in  the  treatment 
of  disease. 

To  the  favorable  opinions  already  accorded  to  the  former  edition  of  this  treatise  we 
can  add  nothing,  except  in  the  way  of  sincere  commendation  ;  and  to  Dr.  Althaus  belongs 
the  credit  of  having  filled  up  a  hiatus  in  English  medical  literature,  by  the  production 
of  a  sound,  comprehensive,  and  practical  work  on  the  right  use  of  an  agent  whose 
powers  are  daily  becoming  better  recognized  and  more  clearly  defined. — JJuhlin  Quar- 
terh/,  May,  1870. 

Tyson's  Work  on  the  Cell  Doctrine. 

The  Cell  Doctrine:  its  History  and  Present  State.  With  a  Copious  Bib- 
liography of  the  Subject.  For  the  Use  of  Students  of  Medicine  and 
Denial  Surgery.  By  James  Tyson,  M.L).,  Lecturer  on  Microscopy  in 
the  University  of  Pennsylvania,  and  on  PJiysiology  in  the  Pennsylvania 
College  of  Dental  Surgery  ;  Fellow  of  the  College  of  Physicians  of 
Philadelphia,  &g.,  dec.  In  one  volume,  with  a  Colored  Plate,  and 
numerous  Illustrations  on  Wood.     Price,  .         .         .         $2  00 

Dr.  Tyson  furnishes  in  this  work  a  concise  and  instructive  resume  of  the  origin  and 
advance  of  the  doctrine  of  Cell  evolution.  In  it  we  find  the  theories  of  Virchow,  Robin, 
Huxley,  Hughes,  Bennett,  Beale,  and  other  distinguished  men.  its  pages  contain  what 
could  otherwise  only  be  learned  by  the  perusal  of  many  works,  and  supplies  the  reader 
with  a  continuous,  complete,  and  general  knowledge  of  the  history,  progress,  and 
peculiar  phases  of  the  Cell  Doctrine,  accompanied  by  careful  references  and  a  copious 
bibliography. 

Lesrs"  on  Urine,  from  the  second  london  edition. 

A  Guide  to  the  Examination  of  the  Urine.  For  the  Practitioner  and 
Student.  By  J.  Wickiiam  Lego,  M.D.,  Member  of  the  Royal  College 
of  Physicians,  &c.,  &c.    Second  Edition.     16ino.    Cloth.    Price,  75  cts. 

Dr.  Lcgg's  little  manual  has  met  with  remarkable  success,  and  the  speedy  exhaustion 
of  the  first  edition  has  enabled  the  author  to  make  certain  emendations  which  have 
added  greatly  to  its  value.  We  can  now  confidently  commend  it  to  the  student  as  a 
safe  and  reliable  guide  to  such  examinations  of  the  urine  as  he  may  be  called  upon  to 
make. — London  Medical  Times  and  Gazette. 

Kirkes'  Hand-Book  of  Physiology. 

THE  SEVENTH  LONDON  EDITION. 

HAND-BOOK  OF  PHYSIOLOGY,  by  William  Senhouse  Kirkes. 
M.D.  Seventh  Edition,  Edited  by  W.  Morrant  Baker,  F.R.C.S.,  Lec- 
turer on  Physiology,  &c.,  &c.  With  241  Illustrations.  In  one  volume, 
demy-octavo,  containing  over  800  pages.     Price,  bound  in  cloth,  $5  00 

This  edition  of  Dr.  Kirkes'  Hand-Book  of  Pliysiology  is  fully  brought  up  to  the  tiu\es, 
and  forms  one  of  the  most  complete  and  convenient  Text-Books  on  the  subject,  for  the 
Student  of  Medicine,  now  in  print. 


J.  Soelberg  Wells  on  the  Eye. 

A  NEW  ENLARGED  LONDON  EDITION. 

A  Treatise  on  Diseases  of  the  Eye  (the  Author's  Second  Edition),  illus- 
trated by  Colored  Plates  and  7iumerous  Engravings  on  Wood.  By 
J.  ScELBERG  Wells,  Professor  of  Ophthalmology  in  King's  College, 
London,  &c.,  &c.  The  plates  and  letter-press  elegantly  printed  on 
cream-tinted  paper.  Octavo,  bound  in  Cloth.  Price,  .  .  $6  50 
Do.  "  Leather,     "         .         .       1  50 

THE  AUTHOR'S  PREFACE  TO  HIS  SECOND  EDITION, 
It  has  afforded  me  no  small  gratification  that  the  First  Edition  of  this  work  should 
have  met  with  so  favorable  a  reception,  both  by  the  Profession  at  large  and  by  the 
British  and  Foreign  Medical  Press,  and  especially  that  it  should  have  been  deemed 
worthy  of  being  translated  into  French  and  German,  in  both  of  which  languages  it  will 
be  published  in  the  course  of  this  year. 

Stimulated  by  such  encouragement,  I  have  endeavored  to  render  the  Second  Edition 
as  complete  as  possible,  and  have  made  numerous  additions,  incorporating  all  the 
important  facts  elucidated  by  the  most  recent  researches,  so  that  the  work  might  be 
brought  up  to  the  latest  date. — 16  Saville  Row,  London,  May,  1870. 

Coles  on  Deformities  of  the  Mouth. 

SECOND  EDITION,   NOW  READY. 

On  Deformities  of  the  Mouth,  Congenital  and  Acquired,  with  their 
Mechanical  Treatment.  By  James  Oakley  Coles,  Dentist  to  the 
Hospital  for  Diseases  of  the  Throat,  Member  of  the  Odontological 
Society,  &c.,  &c.  Second  Edition,  Revised  and  Enlarged,  containing 
EUjJit  Colored  Plates  and  Flfiy-one  Enaravings  on  Wood. 
One  Yolume,  Demy-Octavo,  in  Cloth.     Price,      .         .         .         S2  50 

OPINIONS  OF  THE  PRESS  ON  FIRST  EDITION. 

"This  work  is  full  of  useful  information.  The  records  of  cases  treated  are  most 
encouraging." — Lancet. 

"This  beautifully  illustrated  work  deals  with  a  highly  practical  and  interesting 
subject." — Medical  Times  and  Gazette. 

"We  take  pleasure  in  commending  it  as  a  valuable,  and  therefore  desirable,  treatise 
to  possess." — Dental  Cosmos. 

Neumann's  Hand-Book  of  Skin  Diseases. 

Translated  from  the  Author's  Second  Edition.    IN  PEEPAEATIOE". 

A  Hand-Book  of  Stin  Diseases,  illustrated  by  Forty-nine  Wood  Cuts 
of  large  size,  beautifully  executed,  and  showing  the  Microscopic  Ap- 
pearance of  Sections  of  the  Skin  in  its  Vai'ious  Diseases.  By  Prof. 
Neumann,  of  A^ienna.     In  one  Volume. 

Dr.  Neumann  was  for  a  long  time  Prof.  Hebra's  assistant,  and  his  work  is  a  concise 
treatise  founded  on  "Hebra's"  Doctrines  and  Methods  of  Treatment,  as  the  latter  work 
may  not  for  a  long  time  be  completed,  and  as  from  its  size  and  its  publication  in  the 
English  language  only  by  the  New  Sydenham  Society,  it  cannot,  even  when  all  published, 
be  accessible  but  to  a  limited  number.  This  work  presenting  his  views,  must  necessarily 
prove  a  great  acquisition  to  the  profession. 


LINDSAY  &  BLAKISTON'S 

MEDICAL  PUBLICATIONS. 


"The  Representative  Book  of  Medical  Science.^^ — London  Lancet. 

Aitken's  Science  and  Practice  of  Medicine. 

SECOND  AMEEICAN  from  the  riPTH  LONDON  EDITION, 
lu  2  Volumes,  containing  liUOO  Royal  Octavo  Pages,  a  COLORED  MAP,  a  LITHOGRA- 
PHIC PLATE,  and  ONE  HUNDRED  AND  THIRTY  ILLUSTRATIONS  ON  WOOD. 
Price,  bound  in  Cloth,  bevelled  boards        ....         $12.00 

Leather  . U -'O 

Dr.  Aitken's  work  is  now  the  most  comprcliensive  Text-Book  on  tlie  Practice  of 
Medicine  in  the  English  Language;  the  present  edition  has  been  enlarged  and  care- 
fully revised  by  the  author,  as  well  as  by  the  American  editor,  Meriditii  Clymer,  M.D., 
the  latter  having  made  additions  of  original  matter  equal  to  nearly  500  pages  of  the 
Eiiflish  Edition,  with  special  reference  to  the  wants  of  the  American  Practitioner. 

Acton  on  the  Functions  and  Disorders  of  the 
Reproductive  Organs. 

Second  A  merican  from  the  Fourth  London  Edition.  Carefully  revised  by 
the  author,  with  additions.     Just  Ready,  octavo,     .         .         .         $3.00 

"We  think  Mr.  Acton  haa  done  good  service  to  society  hy  grappling  ninnfiilly  with  eeinal  vice,  and  w« 
trust  that  others,  whose  position  as  men  of  science  and  teachers  enal^le  tlieui  to  speak  with  auUinrity,  will 
assist  in  combating  and  arresting  the  evils  which  it  entails.  We  are  of  the  opinion  that  the  spirit  which 
pervades  it  is  one  that  does  credit  equally  to  the  head  and  to  the  heart  of  the  author." —  T/ie  BniUk  and 
Foreign  Mtdico-CldrurgicaX  Review. 

Anstie  on  Stimulants  and  Narcotics. 

Their  Mutual  Relations,  with  Special  Researches  on  the  Action  of  Alcohol, 
Ether,  and  Chloroform  on  the  Vital  Organism.  By  Francis  E.  Anstie, 
]M.D.,  Assistant  Physician  to  Westminster  Hospital,  Lecturer  on  Materia 
Medica  and  Therapeutics,  etc.,  etc.     Octavo,   ....         83.00 

Althaus'  Medical  Electricity,    a  New  and  very  Much 

Enlarged  Edition. 
A  Theoretical  and  Practical  Treatise,  and  iti^  Ui^e  in  the  Treatment  of 
Paralysis,  Neuralgia,  and  other  Diseases.  By  Julius  Althaus, 
M.  D.,  Member  of  the  Royal  College  of  Physicians,  &c.  Second 
Edition,  revised,  enlarged,  and  for  the  most  j)art  rewritten.  In  One 
Volume  Octavo,  loith  a  Lithographic  Plate  and  >iixty-two  Illustrations 
on  Wood      Price, $5.00 


LINDSAY    AND    BLAKISTOX'S    PUBLrCAlIONS, 

PEOF.  BYFORD'S  NEV/  EDITION 

OF 

The  Practice  of  Medicine  and  Surgery , 

Applied  to  the  Diseases  and  Accidents  Incident  to  Womeii.  By  \V.  H. 
Byford,  a.  M.,  M.  D.,  Professor  of  Obstetrics  and  Diseases  of  Women 
and  Children  in  the  Chicago  3Iedical  College,  do.,  tfcc.  The  Second 
Edition,  revised  and  enlarged,  vsith  additional  illustrations.  One 
volume  octavo. 

Bound  in  Cloth.     Price,  ....  .         ^.00 

Leather, 6.00 

The  rapid  sale  of  the  first  edition  of  this  book,  which  was  exhausted  in  a  little  more 
than  a  year,  has  enabled  the  author  to  carefully  revise  the  whole  work,  add  many 
improvements,  and  to  make  a  large  addition  of  new  matter,  without,  however,  materially 
increasing  the  size  of  the  volume. 

"  Professor  Byford's  book  may  safely  be  said  to  fill  a  gap  in  a  most  important  department  of 
the  healing  art.  The  treatise  is  as  complete  a  one  as  the  present  state  of  our  scionce  will  admit 
t'f  being  written,  and  not  only  gives  us  the  cases  in  which  the  knife  is  to  be  called  into  requisi- 
tion, but  fully  discusses  all  those  uterine  ailments  which  are  to  be  benefited  by  medical  treat- 
ment. In  this  latter  respect,  the  work  has  a  peculiar  value  to  every  general  practitioner.  The 
author  speaks  from  experience,  evidently  with  the  sole  object  of  presenting  his  subject  in  a 
strictly  iiu])artial  and  scientific  light.  The  present  edition  is  much  enlarged  in  point  of  matter 
contained  in  the  work,  although  the  volume  itself  is  very  little,  if  any,  increased  in  bulk.  We 
commend  it  to  the  diligent  study  of  every  practitioner  and  student,  as  a  work  calculated  to 
inculcate  sound  principles,  and  lead  to  enlightened  practice." — N.  Y.  Med.  Kecord. 

"This  work  treats  well-nigh  all  the  diseases  incident  to  women,  diseases  and  accidents  of 
the  vulva  and  perineum,  stone  in  the  bladder,  inflammation  of  the  vagina,  menstruation  and 
its  disorders,  the  uterus  and  its  ailments,  ovarian  tumors,  diseases  of  the  mammte,  puerperal 
convulsions,  phlegmasia  alba  doleus,  puerperal  fever,  <fcc.  Its  scope  is  thus  of  the  most 
extended  character,  yet  the  observations  are  concise,  but  convey  much  practical  information." — 
London  Lancet. 

BYFORD  ON  THE  UTERUS.— PREPARING. 
A  Xetv,  Enlarged,  and  III iisf rated  Edition. 

On  the  Chronic  Inflammation  and  Displace- 
ments of  the  Unimpregnated  Uterns. 

A  New,  Enlarged,  and  Thoroughly  Revised  Edition,  with  Illustrations. 
One  Volume.     Octavo. 

Biddle'S   Materia  MediCa.    The  Third  Edition  Enlarged. 

For  the  Use  of  Students.  A  Nexv  Enlarged  Edition.  W'dh  TlhutratMrn. 
By  J.  B.  BiDDLE,  M.  D.,  Professor  of  Materia  Medlca  and  Therapeutics 
in  the  Jefferson  Medical  College,  Philadelphia,  &c.,  &c.     Octavo.      $4.00 

This  is  a  thoroughly  revised  and  enlarged  edition  of  Prof.  Biddle's  work  on  Materia 
Medica.  It  is  designed  to  present  the  leading  facts  and  principles  usually  comprised 
under  this  head,  as  Bet  forth  by  the  standard  authorities,  and  to  fill  a  vacuum  which 
seems  to  exist  in  the  want  of  an  elementary  work  on  the  subject.  The  larger  works 
usually  recommended  as  Text-Books  in  our  Medical  Schools  are  too  voluminous  for 
convenient  use.  This  work  will  be  found  to  contain,  in  a  condensed  form,  all  that  is 
most  valuable,  and  will  supply  students  with  areUable  guide  to  the  courses  of  lectures 
»B  Materia  Medica,  as  deliTwed  at  the  various  Medical  Schools  in  the  United  States 


LINDSAY    AND    BLAKISTONS    PUBLICATIONS. 


Beasley's  Book  of  Prescriptions. 

A   NEW,    REVISED,   AND   ENLARGED   EDITION. 

Containing  3000  Prescriptions,  collected  from  the  Practice  of  the  most 
Eminent  Physicians  and  Surgeons  —  En  glUh,  French,  and  American; 
coviprising  also  a  Compendious  History  of  the  Mata-ia  Medica,  Liits  of 
the  Doses  of  all  Officinal  and  Established  Preparations,  and  an  Index  of 
Diseases  and  their  Remedies.  By  Henry  Beasley.  Second  American 
from  the  last  London  Edition.     Octavo.  ....         $4.00 

"  The  editor,  carefully  Beli-cting  from  the  mass  of  materials  at  his  disposal,  has  compiled  a  volume,  in  which 
both  physician  and  diuggist,  prescriber  and  compounder,  may  find,  under  the  head  of  each  remedy,  the  man- 
ner in  which  that  renieiiy  may  be  most  effectively  administered,  or  combined  with  other  medicines  in  the 
treatment  of  various  diseases.  The  alphabetical  arrangement  adopted  renders  this  eaay ;  and  the  value  of  the 
volume  is  still  further  enhanced  by  the  short  account  given  of  each  medicine,  and  the  lists  of  doses  of  it? 
several  preparations.  It  is  really  a  most  useful  and  important  publication,  and,  from  the  great  aid  which  it 
1b  capable  of  affording  in  prescribing,  should  be  in  tlie  possession  of  every  niedical  practitioner.  Amongst 
other  advantages  U,  that,  by  giving  the  prescriptions  of  some  of  the  most  able  and  successful  practitioners  of 
the  day,  it  affords  an  insight  into  the  methods  of  treatment  pursued  by  them,  and  of  tlie  remedies  which  thej 
chiefly  employed  in  the  treatment  of  different  diseases."  —  Lancet. 

Beasley's  Druggists'  General  Receipt  Book. 

SIXTH  AMERICAN  EDITION,  REVISED  AND  IMPROVED. 

Comprising  a  copious  Veterinary  Formulary,  numerous  Receipts  of  Patent 
and  Proprietaiy  Medicines,  Druggists'  Nostrums,  etc. ;  Perfumery  and 
Cosmetics,  Beverages,  Dietetic  Articles  and  Condiments,  Trade  Chemicals, 
Scientific  Processes,  and  an  Appendix  of  Useful  Tables,  by  Henry 
Beasley,  Author  of  the  Book  of  Prescriptions,  etc.,  etc.  Sixth  American 
from  the  Last  London  Edition.     Octavo.        ....         $3.50 

"This  is  one  of  the  class  of  books  that  is  indispensable  to  every  Druggist  and  Pharmaceutist  as  a  book  of 
reference  for  such  information  as  is  wanted,  not  contained  in  works  used  in  the  regular  line  of  his  business, 
and  we  can  recommend  it  as  one  of  the  best  of  the  kind."  —  American  Druggists'  Circular. 

Barth  &  Roger's  Manual  of  Auscultation  and 
Percussion. 

A  new  American  Translation  from  the  Sixth  French  Edition.    16mo.    $1.25. 

"This  is  one  of  the  most  useful  and  practical  manuals  of  its  sort  that  has  ever  yet  appeared,  and  we  can- 
not too  strongly  recommend  it  to  every  student  of  medicine.  It  is  sufficiently  comprehensive  without  being 
lengthy,  and  the  principles,  wluch  are  eminently  sound,  can  easily  be  mastered  and  understood." —  Medical 
Becord. 

Bouchardat's  Annual  Abstract 

Of  Therapeutics,  Materia  Medica,  Pharmacy,  and  Toxicology, 
FOR  1867,  with  an  Original  Memoir  of  Gout,  Gravel,  Urinary  Cal- 
culi, &c.  By  A.  Bouchardat,  Professor  of  Hygiene  to  the  Faculty 
of  Medicine,  Paris,  &c.  Translated  and  Edited  by  M.  J.  De  Rosset. 
M.  D.,  Adjunct  to  the  Professor  of  Chemistry  in  the  University  of 
Maryland.     In  one  Volume.     Price,  in  cloth,         .  .  |1.5u. 


LINDSAY    AND    BLAKTSTON'S    PUBLICATIONS. 

Andrews'    Hand-Book   of  the    Practice    of 

Medicine,     in  Preparation. 

Bull  on  the  Maternal  Management  of  Chil- 
dren in  Health  and  Disease. 

A  New  and  Improved  Edition.    Bj  Thomas  Bull,  M.  D.,  Member  of  the 
Royal  College  of  Physicians.      12mo $1.25 

Reports  on  the  Progress  of  Medicine,  Surgery, 
and  the  Allied  Sciences,  containing: 

1.  Report  on  Physiology,  by  Henry  Power,  F.R.C.S.,  M.B.,  Lond. 

2.  Report  on  Practical  MEDici>fE,  by  Francis  Edmund  Anstie,  M.D.,  etc. 

3.  Report  on  Surgery,  by  T.  Holmes,  Esq.,  M.A.,  F.R.C.S.,  etc. 

4.  Report  on  Ophthalmic  Medicine  and  Surgery,  by  Thomas  Windsor,  M.D. 

5.  Report  on  Midwifery  and  the  Diseases  of  Women  and  Children,  by  R.  Barnes, 
M.D.,  F.R.C.P. 

6.  Report  on  Medical  Jurisprudence,  by  C.  Hilton  Fagge,  M.D.,  F.R.C.P. 

7.  Report  on  Materia  Medica  and  General  Therapeutics,  by  C.  Hilton  Fagge,  M.D., 
F.R.C.P. 

8.  Report  on  Public  Health,  by  C.  Hilton  Fagge,  M.D.,  etc. 

In  One  Yolume,  handsomely  bound  in  cloth,  Price,  .         .         $2  00 

"This  volume,  published  under  the  auspices  of  the  New  Sydenliam  Society,  now  makes  its  welcome  appear- 
ance, at  a  low  price,  in  the  United  States.  It  is  the  most  carefully  prepared  retrospect  with  which  we  are 
acquainted.  Each  department  is  in  charge  of  a  gentleman  of  reputation,  and  everything  is  done  to  sum. 
marize,  in  a  very  readable  way,  all  the  more  important  advances  of  medicine  over  the  globe.  It  is  hand- 
somely bound  and  elegantly  printed." — N.  T.  Medical  Record. 

Birch   on    Constipation.     From  the  Third  London  Edition. 

CONSTIPATED  BOWELS;   the  various   Causes  and  the  Different 

Means  of  Cure.     By  S.  B.  Birch,  M.  D.,  Member  of  the  Fioyal  College 

of  Physicians  of  London,  &c.    The  Third  Edition.    One  volume,  16mo. 

Price, .         .         .         .        $1.00 


Braithwaite's  Epitome  of  the  Retrospect  of 
Practical  Medicine  and  Surgery. 

Two  large  Octavo  Volumes  of  900  pages  each,  .         .        .         $10.00 

Braithwaite's  Retrospect  of  Practical  Medi- 
cine and  Surgery. 

"The  cream  of  medical  literature." 

Published  half-yearly,  in  January  and  July,  at  82.50  per  annum,  if  paid  in 
advance;  or  $1.50 /or  single  parts. 


LINDSAY    AND    BLAKISTON  S    PUBLICATIONS. 


British  and  Foreign  Mcdico-Chirurgical  Re- 
view, and  Quarterly  Journal  of  Practical 
Medicine  and  Surgery. 

Published  in  London  on  the  1st  of  January,  April,  July,  and  October,  o.i 
6  shillings  per  uurnber,  or  24  shillings  per  annum,  and  furnished  in  OlIs 
country  at  $10.00  per  annum;  being  much  less  than  the  present  cost  of 
importation  of  English  books.  Containing  Analytical  and  Critical  Re- 
views, a  Bibliographical  Record,  Original  Communications,  and  a  Chron- 
icle of  Medical  Science,  chiefly  Foreign  and  Contemporary. 

This  is  considered  the  leading  Medical  Review  in  the  English  language.  It  is  every- 
where looked  upon  as  high  authority.  It  presents  in  its  pages  a  large  amount  of  valu- 
able and  interesting  matter,  and  will  post  the  physician  who  reads  it,  fully  up  to  ihe 
present  day  in  medical  literature. 

Chambers's  Lectures  on  the  Renewal  of  Life. 

A  Ne^w  American  from  the  Fourth  London  Edition. 

Lectures  chiefly  clinical,  illustrative  of  a  Restorative  System  of  Medicine. 
By  Tiios.  K.  Chambeus,  M.  D.,  Physician  to  St.  Mary^s  Hospital. 
Author  of  "  The  ludigestions,"  &c.,  &c.     Octavo,         .         .         $5.00 

"  The  medical  profession  in  this  country  are  under  obligations  to  the  American  publishers 
for  this  reprint  of  Dr.  Chambers'  Lectures  —  a  work  whose  time  is  forever,  everywhere  in  its 
place,  admirable  in  tone,  full  of  valuable  instructions  and  practical  teachings,  and  written  in 
clear,  compact,  and  often  epigrammatic  English.  We  can  offer  but  a  brief  notice  of  this  intrin- 
sically good  book,  which  is  certain  of  finding  a  wide  circle  of  readers,  and  we  should  hope  a 
place  in  every  medical  library." — Neto  York  Medical  Journal. 

"This  work  is  of  the  highest  merit,  written  in  a  clear,  masterly  style,  and  devoid  of  technicalities.  It  is 
■imply  what  it  professes  to  be,  Lectures  Clinical,  delivered  from  cases  observed  at  the  bedside;  therefore 
more  valuable  as  enunciating  the  views  and  e.xpcrionces  of  a  practical  mind  aided  by  actual  observation. 

They  are  of  deep  interest,  and  replete  with  facts  having  a  practical  bearing,  and  will  well  repay  perusal 

We  can  recommend  Dr.  Chambers'  book  freely  and  with  confidence,  as  the  work  of  a  great  mind  practical  in 
its  bearing,  and  simple  to  the  understanding  of  all." —  Canada  Medical  Journal. 

Chew  on  Medical  Education. 

A  Course  of  Lectures  on  the  Proper  Method  of  Studying  Medicine.  By 
Samuel  Chew,  M.D.,  Professor  of  the  Practice  and  Principles  of 
Medicine  and  of  Clinical  Medicine  in  the  University  of  Maryland. 
12mo Sl.OO 

" The  topics  discussed  in  this  volume  are  of  books  — of  time  to  be  devoted  tostudy  —  and  the  manner  — of 
the  order  of  medical  studies  —  of  the  taking  of  notes  — of  clinical  instruction  —  dissections  —  auscultation  — 
meiUcal  ichools,  &c. 

"Dr.  Chew  was  an  eminent  member  of  the  medical  profession,  and  a  well-Known  teacher  of  medicine.     He 
was,  there/ore,  well  fitted  for  the  judicious  performance  of  this  task,  upon  which  he  seems  to  have  eiitcivd 
(rith  interest  and  pleasure.     It  is  a  well-timed  book,  and  will  serva  as  a  most  excellent  manual  for  thestudint. 
«a  well  ai  a  refreshing  and  suggestive  one  to  the  practitioner."  —  Lancet  and  Observa. 
•i 


LINDSAY    AND    BLAKTSTON's    PUBLICATIONS. 


Cazeaux's  Great  Work  on  Obstetrics. 

The  Fifth  American  Edition.     175  IllustratioDB. 

A  Theoretical  and  Practical  Treatise  on  Midwifery.  Including  the  Dis- 
eases of  Pregnancy  and  Parturition,  and  the  attention  required  by  the 
Child  from  its  Birth  to  the  Period  of  Weaning.  By  P.  Cazeaux, 
Member  of  the  Imperial  Academy  of  Medicine,  Adjunct  Professor  in 
the  Faculty  of  Medicine  of  Paris,  £c.,  So.  Bevif^ed  and  annotated 
by  S.  Tarmfai,  Adjunct  Professor  to  the  Faculty  of  Medicine,  Paris, 
&c.,  &c.  Translated  by  W.  R.  Bullock,  M.  D.  With  new  Litho- 
graphic and  other  Illustrations  on  Wood.  One  volume  Royal  Octavo, 
of  over  1100  pages. 

Price,  bound  in  Cloth,  Bevelled  Boards,         ....    $(^50 
Leather, 7.50 

"Written  expressly  for  tlie  use  of  studeuts  of  medicine,  and  those  of  midwifery  especially,  its  teachings  are 
plain  and  explicit,  presenting  a  condensed  summary  of  the  leading  principles  established  by  the  maste:8  of 
tee  obstetric  art,  and  such  clear,  jiractital  directions  for  the  management  of  the  pregnant,  parturient,  anH 
puei  r>eral  states,  as  have  been  sanctioned  by  tlie  most  authoritative  practitioners,  and  confirmed  by  the 
iUitbor'B  own  experience.  Collecting  his  materials  from  the  writings  of  the  entire  body  of  antecedent  writers, 
carefully  testing  th^r  correctness  and  value  by  bis  own  daily  experience,  and  rejecting  all  such  as  were  falsi- 
fied by  the  numerous  cases  brought  under  bis  own  immediate  obseivation,  he  has  formed  out  of  them  a  body 
of  doctrine,  and  a  system  of  practical  rules,  which  he  illustrates  and  enforces  in  the  clear&et  and  most  simpl* 
maimer  possible."  —  Examiner. 

Canniff 's  Manual  of  the  Principles  of  Surgery, 

Based  on  Pathology,  for  Students,  by  "NVm.  Canniff,  Licentiate  of  the 
Medical  Board  of  Upper  Canada;  M.D.  of  the  University  of  New 
York ;  M.R.  C.S.  of  England ;  forvxerly  House  Surgeon  to  the  Seamen^s 
Hospital,  New  York;  late  Professor  of  General  Pathology  and  the 
Principles  and  Practice  of  Surgery,  University  Victoria  College.  C.  W. 
Octavo $4.50 

"This  manual  is  evidently  the  production  of  a  man  who  is  well  informed  on  his  subject,  and  who  moreoyei 
has  had  experience  as  a  teacher  and  as  a  practitioner.  He  has  prulited  by  the  study  of  the  best  authors  on 
the  principles  of  surgery,  tested  practically  tlieir  doctrines,  and  b:i3  presented  bis  own  views,  well  arranged 
and  clearlj'  expressed,  for  the  advantage  of  others."'  —  Amivican  Journal  of  Med.  Science. 


Cleaveland's  Pronouncing  Medical  Lexicon. 

A  NEW  AND   IMPROVED    EDITION  (THE   ELEVENTH). 

Containing  the  Correct  Pronunciation  and  Definition  of  most  of  the  Terms 
vsed  by  Sfjeakers  and  Writers  of  Medicine  and  the  Collateral  Sciences. 
By  C.  H.  Cleaveland,  M.D.,  Member  of  the  American  Medical  Associa- 
tion, etc.,  etc.     A  small  Pocket  Volume $1.25 

This  little  work  is  both  brief  and  comprehensive;  it  is  not  only  a  Lexicon  of  all  the 
words  in  common  use  in  Medicine,  but  it  is  also  a  Pronouncing  Dictionary,  a  feature 
of  great  value  to  Medical  Students.  To  the  Dispenser  it  will  prove  an  excellent  aid, 
and  also  to  the  rharmaccutical  Student.  This  edition  contains  a  List  of  the  Abbrevia- 
tions used  in  Prescriptions,  together  with  their  meaning;  and  also  of  Poisons  and  their 
Antidotes:  two  valuable  additions.  It  has  received  strong  commendation  both  from  the 
Medical  Pre«8  and  from  the  profession. 


LINDSAY   AND   BLAKISTON'S    PUBLICATIONS. 


Cohen  on  Iiilialalioii. 

lis  T/ierapeutics  and  PracLice.  A  Treatise  on  the  Inhalation  of  Gases, 
Vapors,  Nebulized  Fluids,  and  Fowders ;  including  a,  Descriijlion  of 
the  Apparatus  employed,  and  a  Record  of  Numerous  Experiments, 
Physiolo'jical  and  Palhological ;  with  Cases  and  Illustrations.  15y  I. 
SoLis  Cohen,  M.D.     12mo.     Price, $2  50 

"We  recognize  in  this  boi>k  the  work  of  a  persevering  Physician  who  has  faithfully 
studied  his  subject,  and  added  to  its  literature  much  that  is  useful  from  his  own  expe- 
rience. It  treats  respectively  of  the  inhalations  of  nebulized  fluids ;  of  medicated  airs, 
gases,  and  /apors,  and  of  powders.  Dr.  Cohen  has  given  us  briefly  and  clearly  what- 
ever is  valuable  in  relation  to  the  insufflation  of  powders  in  respiratory  afl'ections,  with 
the  experimental  proofs  and  pathological  evidence  of  their  penetration  into  the  bron- 
chial tubes  and  lung  tissues." — American  Journal  of  Medical  Science,  July,  18tj8. 

Prof.  Carson's  University  of  Pennsylvania. 

A  History  of  the  Medical  Department  of  the  University  of  Pennsylvania, 
from  its  Foundation  in  1765:  With  Hkelches  of  the  Lives  of  Deceased 
Professors.  By  Joseph  Carson,  M.D.,  Professor  of  Materia  Medica 
and  Pharmacy  in  the  University  of  Penyisylvania;  Member  of  the 
Ame7-ican  Philosophical  Society,  etc.  In  cue  volume  octavo.  Cloth. 
Price, S2  00 

"The  history  of  the  University  of  Pennsylvania  has  a  national  as  well  as  a  locai 
interest,  from  the  early  date  of  its  origination,  and  the  connection  witli  it  of  men  of 
illustrious  public  reputation,  such  as  Drs.  Franklin,  Hush,  Physick,  Gibson,  Dewees, 
Chapman,  Wood,  &c.,  &c. 

'•For  fidelity  and  carefulness  of  statement  and  maintenance  of  the  dignity  of  the 
Institution,  as  well  as  for  skill  in  literary  execution,  the  task  of  extending  and  con^ 
tinuiug  this  record  could  have  been  confided  to  no  better  hands  than  those  of  Professor 
Carson. 

"For  the  labor  and  love  which  he  has  spent  in  preparing  this  most  interesting  and 
valuable  work.  Prof.  Carson  has  earned  the  gratitude  of  the  alumni  of  the  University, 
and  of  all  others  interested  in  medical  education  in  this  country."  —  American  Journal 
of  Mtdical  Science. 

DivrMT    r\n    flin  Ji^\rr^     1    A  New  Edition,  thoroughly  Eevised,  and  a 
IXOll    Ull    lllb  ±J\  I..    I       great  portion  Ee-written. 

A  Guide  to  the  Practical  Study  of  Diseases  of  the  Eye,  with  an  Outline 
of  their  Medical  and  Operative  Treal,ment,  with  Test  Types  and  Illus- 
trations. By  James  Dixon,  F.R.C.S.,  Surgeon  to  the  Boyal  London 
Ophthalmic  Hospital,  &c.,  &c.     In  one  volume.     Price,       .         $2  50 

"  Mr.  Dixon's  book  is  essentially  a  practical  one,  written  by  an  observant  author, 
who  brings  to  his  special  subject  a  sound  knowledge  of  general  Medicine  and  Surgery." 
—  Dublin  Quarterly. 

"Our  object  is  not  to  review,  but  to  recommend  this  work  to  students,  with  the  confi- 
dent assurance  that  they  will  rarely  be  disappointed  in  their  appeals  to  it  as  a  reliable 
guide  to  the  practical  study  of  the  Diseases  of  the  Eye." — American  Medical  Joiirnai. 

"  We  have  taken  great  pleasure  in  a  careful  perusal  of  this  book,  which,  both  in  style 
and  matter,  is  unsurpassed  in  any  language  It  embraces  quite  a  wide  riinge  of  topics, 
and  furnishes  a  very  valuable  practical  guiile  in  the  medical  and  surgical  treatment 
of  diseases  of  the  eye." — Buffalo  Medical  Journal. 


LINDSAY    AND    BLAKISTON'S    PUBLICATION'S. 


Durkee  on  Gonorrhoea  and  Syphilis. 

The  Fifth  Edition,  Revised  and  Enlarged,  with  Portraits  and  Colored 

Illustrations. 

A  Treatise  on  Gonorrhoea  and  Syphilis.  By  Silas  Durkee,  ISI.D.,  Fel- 
low of  the  Massachusetts  Medical  Society,  &c.,  &c.  A  New  and  Revised 
Edition,  with  Eight  Colored  Illustrations.     Octavo.        .         .         S5.00 

This  work  of  Dr.  Durkee's  has  received  tlie  unqualified  approval 
of  the  Medical  Press  and  the  Profession  both  in  this  country  and  in 
Europe.  The  author  has  devoted  himself  especially  to  the  treatment  of 
this  class  of  diseases,  and  his  25  or  30  years  experieuce  in  doing  so  is 
here  recorded.  No  one  reading  his  work  can  fail  in  receiving  very 
valuable  information  from  it. 

"  It  is  the  work  of  a  practical  man,  the  subject  is  treated  in  a  plain,  shrewd  manner.  The 
book  is  a  good  one,  and  the  therapeutics  are  laid  down  with  discrimination."  —  Liyndon  Medical 
Times  and  Gazette. 

"  Dr.  Durkee's  production  ie  one  of  those,  the  perusal  of  which  impresses  the  reader  in  favor  of  the  author. 
The  gencnil  tonn.  the  thorough  honesty  erfrywliere  evinced,  the  iihiIanthrop:c  siiirit  oliscrvahie  in  many  pas- 
Bagee,  and  tlie  energetic  advocacy  of  professional  rectitude,  speak  biglily  of  the  moral  excellence  of  the 
writer;  nor  is  the  reader  less  attracted  by  the  skill  with  which  the  book  is  arranged,  the  manner  in  which 
th"  facts  are  cited,  the  clever  way  in  which  the  author's  e.-;perience  is  brought  in,  and  the  lucidity  of  th« 
reasoning,  tlie  lix-'Hiciit  aticl  extremely  f  lir  allusions  to  the  labora  of  others,  and  the  Care  with  which  the  the- 
rapeutics of  venereal  compluiuts  are  treated."  —  Lancet. 

Fuller  on  Rheumatism^  Rheumatic  Gout,  and 
Sciatica,    a  new  editiox  preparing. 

Their  Pailiolocjy,  Sy7V2:)toms,  and  Treatment.  By  Henry  William 
Fuller,  M.D.,  Fellow  of -the  Royal  College  of  Physicians,  London; 
Physician  to  St,  George's  Hospital,  etc.  From  the  last  London  Edition. 
Octavo. 

Graves'  Clinical  Lectures  on  the  Practice  of 

Medicine.  %  Robert  James  Graves,  M.D.,  F.R.S.,  Professor 
of  the  Institutes  of  Medicine  in  the  School  of  Physic  in  Ireland.  Edited 
by  J.  Moore  Meligan,  M.D.  From  the  Second  Revised  and  Enlarged 
Edition.     Complete  in  One  Volume.     Octavo.     Price,     .         .         $6.00 

GoiT's  Combined  Day-Book,  Ledger,  and  Dany 

Register  of  Patients,  combining  not  only  the  Accuracy  and  Essential 
Points  of  a  regular  Lay-Book  and  Ledger  System,  without  any  of  the 
labor  and  responsibility,  but  is  also  a  Daily  Register  of  Patients,  &c.,  '&c. 
A  large  Quarto  Volume,  strongly  hound  in  half-russia.  Price,  S12.00 
The  advantages  of  this  book  are  —  The  account  of  a  whole  familj'  for  an  entire  year  can 
be  kept  in  a  very  small  space.  (See  Mitchell's  account.)  No  transfer  of  accounts 
from  one  book  to  another,  or  from  one  part  of  the  book  to  another.  No  protracted 
search  for  an  account  when  wanted.  Shows  the  exact  state  of  an  account  at  anj,' 
moment. 


LINDSAY   AND    BLAKISTOX'S   PUBLICATIONS. 

Gross'  American  Medical  Biography  of  the 
Nineteenth  Century. 

Edited  by  Samuel  D.  Gross,  M.D.,  Professor  of  Surgery  in  the  Jefferson 
Medical  College,  Philadelphia,  &c.,  &c.  With  a  Portrait  of  Benjamin 
Rush,  ]\LD.     Octavo $3.50 

Greenhow  on  Bronchitis,  especially  as  connected  with 

Gout,  Emphysema,  and  Disea^^es  of  the  Heart.     By  E.  Headlam  Green 
HOW,  M.U.,  Fellow  of  the  Royal  College  of  Physicians,  &c.,  &c. 

Price,  $2.00 

"  III  viviii  jiirtiires  of  the  sort  of  cases  which  a  prixctitioner  enronnters  in  his  daily  walks,  and  in  examples 
cf  tlie  way  in  which  a  student  ought  to  turn  them  over  in  liis  mind  and  make  thejn  tools  for  self-improvm 
meut,  we  have  rarely  seen  a  volume  richer."  —  Bi-it.  and  For.  Medico-Chirurg.  Review. 

Garratt's  (Alfred  C.)  Guide  for  Using  Medical 
Batteries. 

Showing  the  most  approved  Apparatus,  Methods,  and  Rides  for  the  Medical 
Employment  of  Electricity  in  the  Treatment  of  Nervous  Diseases,  &c.,  &c. 
With  numerous  Illustrations.     One  Volume,  octavo.       .         .         $2.00 

"The  largo  work  on  the  same  suhjcct,  and  liy  the  same  author,  is  pretty  well  known  to  the  Profevaion,  hut 
It  is  hulky  and  cumbrous,  and  by  no  means  so  practically  useful.  The  present  coniparativtdy  lirief  volume 
:.ontains  every  thiuj;  of  importance  in  regard  to  the  various  apparatuses  useful  to  the  Medical  Electrician 
and  the  various  modes  of  application  foi  therapeutic  purposes." — Lancet  and  Observer. 

Hewitt  on  the  Diseases  of  Women. 

SECOND  EDITION,  REWRITTEN  AND  ENLARGED. 

The-  Diagnosis  and  Treatment  of  Diseases  of  Women,  including  the 
Dia(ja<jsis  of  Pregnancy.  Founded  on  a  Course  of  Lectures  delivered 
at  St.  Mary's  HoKpntal  Medical  School.  By  Graily  Hewitt,  M.  D. 
Loud.,  M.  K.  C.  P.,  Physician  to  the  British  Lying-in  Hospital;  Lec- 
turer on  Midivifery  and  Diseases  of  Women  and  Children  at  St.  3Iary^s 
Hospital  Medical  School;  Honorary  Secretary  to  the  Obstetrical  So- 
ciety of  London,  &c.  With  a  new  Series  of  Illustrations. 
Price,  in  clotli,  $5.00 ;  in  leather,  $G.OO. 

Hfllier's  Clinical  Treatise  on  the  Diseases  of 

Children.     By  Thomas  Hillier,  M.D.,  Physician  to  the  Hosjntal 
for  Sick  Children,  and  to  Unicersity  College  Hospital,  ivc,  &c.     Octavo. 

Price,  $3.00 

"Our  space  is  exhausted,  but  we  have  said  enough  to  indicate  and  illustrate  the  excellence  of  Pr.  Hillier'? 
volume.  It  is  eminently  the  kind  of  book  needed  by  all  medical  men  who  wish  to  cultivate  clini  tal  accwicj 
Mid  sound  practice."  —  London  Lancet. 


liTNDSAY   AND   BLAKISTON's   PUBLICATIONS. 


Headland  on  the  Action  of  Medicines  in  the 
•  System. 

By  F.  W.  IIeadlaxd,  ^M.D.,  Fellow  of  the  royal  College  of  PJiT/sicians- 
d'c.,  d'c.  Sixth  American  frovi  the  Fourth  London  Edition.  Revised 
and  enlarged.     One  Volume,  octavo.     .....         §3.00 

Dr.  Ileadland's  work  Las  been  out  of  print  in  this  country  nearly  two  years,  awp-U- 
ing  the  revinioua  of  the  author,  which  now  appear  in  thia  edition.  It  gives  the  oiilj 
scientific  and  satisfactory  view  of  the  action  of  medicine;  and  this  not  in  the  way  of 
iille  speculation,  but  by  demons'tration  and  experiments,  and  inferences  almost  as  in- 
disputable as  demonstrations.  It  is  truly  a  great  scientific  work  in  a  small  compass, 
and  deserves  to  be  the  handbook  of  every  lover  of  the  Profession.  It  has  received  thf, 
most  unqualified  approbation  of  the  Medical  Pretf,  both  in  this  country  and  in  Europe, 
and  is  pronounced  by  them  to  be  the  most  orif/inal  and  practically  useful  work  that  has 
been  published  for  many  years. 

Eille's  Pocket  Anatomist. 

Being  a  Complete  Description  of  the  Anatomy  of  the  Human  Body ;  for  tho 
Use  of  Stndents.  By  il.  W.  Hilles,  formerly  Lecturer  on  Anatomy  and 
Physiology  at  the  Westminster  Hospital  School  of  Medicine. 

Price,  in  cloth, 81.00 

"      in  Pocket-book  form, 1.25 

Heath  on  the  Injuries  and  Diseases  of  the  Jaws. 

The  Jacksonian  Prize  Essag  of  the  Royal  College  of  Surgeons  of  Eng- 
land, 1867.     By  Christopher  Heath.  F.R.  C.  S.,  Ai^si^tant  Surgeon  to 

University  College  Hospital,  and  Teacher  of  Operative  Surgery  in  Uni- 
versity College.    Containing  over  Ib^i  Illustrations.  Octavo.    Price,  $6.00 

Hodge  on  Foeticide,  or  Criminal  Abortion 

By  Hugh  L.  Hodge,  M.  D.,  Emeriius  Professor  in  the  University  of 
Pennsylvania.     A  Small  Pocket  Volume.       Price  in  paper  covers,      30 

flexible  cloth,     50 

This  little  book  is  intended  to  place  in  the  hands  of  professional  men  and  others  the  means  of  answering 
satisfactorily  and  intelligently  any  inquiries  that  may  be  made  of  them  in  connection  with  this  importanit 
tubject. 

Hohi^es'  Surgical  Diseases  of  Infancy  and 

ChildllOOd.  By  J.  Holmes,  M.A.,  Surgeon  to  the  Hospital  fo^ 
Si;k  Children,  &c.     Second  Edition.     Revised  and  Enlarged.     Octavo. 

Price,  89.00 

Hufeland's  Art  of  Prolonging  Life.     Eduedby 

Erasmus  Wilson,  M.D.,  F  R.S.  Author  of  "A  System  of  Human 
Anatomy,''  ''Diseases  of  the  Skin,^^  &c.,  &c.     12mo.     Cloth.  $1.25 


LINDSAY   AND   BLAKISTON'S    PUBLICATIONS. 

Mackenzie  on  the  Laryngoscope,  Diseases 
of  the  Throaty  &c.     Second  Edition. 

The  Use  of  the  Laryngoscope  in  Diseases  of  the  Throat.  With  additions, 
and  an  Essay  on  Hoarseness,  Loss  of  Voice,  and  Slridulous  Breathing 
in  relation  to  Nervo- Muscular  affections  of  the  Larynx,  by  Morelt 
Mackenzie,  M.D.,  Physician  to  the  Hoxpilal  for  Diseases  of  the  Throat, 
dec,  &c.  Second  Edition,  with  additions,  and  a  Chapter  on  the  Nasal 
Passages,  by  J.  SoLis  CoaiE,N,'M.D.,  Author  of  "  Inhalation,  Its  Thera- 
peutics and  Practice,''''  &c.  Illustrated  by  two  lithographic  plates,  and 
51  engravings  on  wood.     Octavo.     Price,         ....      $3.00 

"While  laryngoscopy  was  in  its  infancy,  end  before  it  had  begun  to  engage  to  any  extent  the  attention  of 
the  Profession,  it  was  s'tiulicd  witli  tlie  greatest  care  ami  eiitliusi:usni  by  the  autlior  of  this  treati.se.  A  per- 
sonal frieud  of  Czermak's,  who  hua  done  wore  thnn  any  other  continental  physician  to  introduce  the  laryimo- 
Bcope  into  practice^  he  lias  profited  l)y  the  oppnrtuiiilii'.s  ivhirli  he  tliu.s  possessud  of  Ijeeoniinn  ac  plain  ted  wilb 
the  anatomy  and  niorliid  anatomy  of  the  larynx.  But  lie  has  done  niuoli  more  than  this.  As  will  be  seen  by 
a  perusal  of  this  treatise,  he  has  modified  the  iii^^lniMients  at  present  in  use  for  the  examination  of  the 
larynx,  and  has  invente<l  others  for  therapeutical  piirpi^i*.  Those  \>ho  are  anxious  to  study  the  disea-ses  of 
the  larynx  and  the  mode  of  using  the  laryngoscope,  cannot  do  better  than  purchase  the  treatise  before  us,  a.s  it 
is  by  far  the  best  which  has  been  pub!i.-.lied,  and  is  thorof  ^hiy  to  be  relieil  upon." — Glasgow  iltdical  Jourtud. 

Morris  on  the  Pathology  and  Therapeutics 
of  Scarlet  Fever. 

By  Casper  Mokris,  ]\I.D.,  Fellow  of  the  College  of  Phtjsicians  of  Phila- 
delpjhia,  &c.,  &c.     A  New  Enlarged  J^dltion.     Octavo.  .         $1.00 

Meigs  and  Pepper's  Practical  Treatise   on 
the  Diseases  of  Children. 

Poixrtli  Edition,  thoroughly  Revised  and  greatly  Enlarged. 

By  J.  Forsyth  Meigs,  M.  D.,  Fellow  of  the  College  of  Physicians  of 

Philadelphia,  &c.,  &c.,and  William  Pepper,  M.D.,  Physician  to  the 

Philadelphia  Hospital,  &c.,  &c.,  forming  a  Royal  Octavo  Volume  of 

over  900  pages.     Price,  bound  in  Cloth,  .         .         .         $6.00 

"  "  Leather,  .         .         .      7.00 

Dr.  Meigs'  work  has  been  out  of  print  for  some  years.  The  rapid  sale  of  the  three  previous  editions,  and  the 
great  demand  for  a  new  edition,  is  sufficient  evidence  of  its  great  popularity:  while  the  very  large  practice 
of  many  years'  standing  of  the  author  in  the  speciality  Of  "  Diseases  of  Children,"  imparts  to  it  a  value  un- 
.'iiualled,  probably,  by  any  other  work  on  the  same  subject  now  before  the  Profession.  This  present  edition  haa 
been  almost  entirely  rewritten  and  rearranged,  and  no  efibrt  or  labor  has  been  spared  by  either  Drs.  Meii?B 
ir  Pepper,  to  make  it  represent  fully  in  its  most  advanced  state  the  present  condition  of  Medicine  as  applied 
to  Children's  Diseases. 

Murphy's  Review  of  Chemistry  for  Students. 

Adapted  to  Vm  Cotirses  as  Taught  in  the  Principal  Medical  Schools  in  the 
United  States.    By  John  G.  Murphy,  jNI.D.    In  One  Volume.     $1.25. 

"  Tliis  is  an  exceedingly  well-arranged  and  converient  Manual.  It  gives  the  most  important  facts  and 
principles  of  Chemistry  in  a  clear  and  very  concise  manner,  so  as  to  subserve  most  admirably  the  object  fM 
wtiich  it  was  designed." — J^orth  Western  Medical  and  SuTfjical  Journal. 


LINDSAY   AND   BLAKISTON'S    PUBLICATIONS. 


Maxson's  Practice  of  Medicine. 

A  Xexv  Text-Book  on  the  Practice  of  Medicine.  By  Edwin  R.  !Max80N, 
^LD.,  formerly  Lecturer  on  the  Institutes  and  Practice  of  Medicine  in  the 
Geneva  Medical  College.     In  One  Volume.     Royal  8vo.         .         $4.00 

"Judging  from  his  work,  he  must  bo  a  correct  observer,  of  plain,  strong  common  seoso,  having  the  pro- 
Tess  ami  perfection  of  the  healiug  art.  and  the  amelioration  of  suffering,  earnestly  at  heart,  free  from  pre- 
tu»lice,  and  open  to  conviction.  The  fact  of  employing,  and  thereuiion  reconiniending  valuable  remedial 
ageot.s,  uM  yet,  for  various  reasons,  under  the  tan,  and  niii^understnod  by  many  pbysiciaas,  is  an  honor  to 
AiuQ,  and  gives  a  certain  additional  value  to  Uia  book."  —  American  Medical  Monthly. 

Meudenliairs  Medical  Student's  Vade  Mecum. 

A  Compendium  of  Anatomy,  Physiology,  Chemistry,  The  Practice  of  Medi- 
cine, Surgery,  Obstetrics,  Diseases  of  the  Skin,  Materia  Medica,  Phar- 
macy, Poisons,  d'c,  &c.  By  George  Mendexhall,  M.D.,  Professor  of 
Obstetrics  in  the  Medical  College  of  Ohio,  Member  of  the  American 
Medical  Association,  &c.,  &c.  The  Eighth  Edition,  Revised  and  En- 
larged ;  with  224  Illustrations $2.50 

"This  volume  puts  the  student  in  possession  of  a  condensed  medical  library.  Its  accuracy  is  a  strong 
recommendation,  while  the  portability  uf  a  volume  containing  the  whole  circle  of  HKMiical  scionc«  is  a  matter 
that  will  have  weight  with  thoso  for  whoso  service  the  l>ook  was  originally  designed.  The  work  is  offered, 
too,  extremely  cheap,  and  will  be  found  a  valuable  assistant  even  to  a  well-informed  practitioner  of  any 
branch  of  medicine."  —  Builun  Medical  and  Surgical  JoumaL 

Paget's  Lectures  on  Surgical  Pathology. 

Delivered  at  the  Royal  College  of  Surgeons  of  England,  by  James  Paget, 
F.R.S.,  Surgeon  to  Bartholoview  and  Christ's  Hospital,  d-c,  dx.  The 
Third  American  from  the  Second  London  Edition,  Edited  and  Revised 
by  "Williabi  Turner,  M.B.,  Lond.  Senior  Demonstrator  of  Anatomy  in 
the  University  of  Edinburgh,  &c.,  dec.  In  One  Volume,  Royai  Octavo; 
with  Numerous  Illustrations. 

Price,  in  bevelled  cloth, $6.00 

"      ill  leather, 7.00 

Pennsylvania  Hospital  Reports.  Edited  by  a  com- 
mittee of  the  Hospital  Staff,  J.  M.  DaCosta,  M.D.,  and  William  Hunt, 
M.D.  Vols.  1  and  2,  for  1868  and  1869,  each,  volume  containing  upwards 
o/Twenty  Original  Articles,  by  former  and  jyresent  Members  of  the.  Staff, 
now  eminent  in  the  Profession,  with  Lithographic  and  other  Illustrations. 

Price  per  volume, $4.00 

At  last,  however,  the  work  has  been  commenced,  the  Philadelphia  Physicians  bemg 
the  first  to  occupy  tliis  field  of  usefulness,  having  issued  the  first  volume  of  the  Reports 
of  the  above  hospital  last  year,  and  the  .second  volume  on  January  1st,  1869.  The  firnt 
Reports  were  so  favorably  received  on  both  sides"  of  the  Atlantic,  that  it  is  hardly 
necessary  to  speak  for  this  volume  the  universal  welcome  of  which  it  is  deserving.  We 
cannot  close  our  remarks  without  stating  that  the  papers  are  all  vnluable  contributions 
to  the  literature  of  medicine,  reflecting  great  credit  upon  their  authors,  and  the  work 
is  one  of  which  the  Pennsylvania  Hospital  may  well  be  proud.  It  will  do  much  toward 
•l^Mtingthe  profession  of  this  country  in  the  estimation  of  their  foreign  brethren." 

— American  Journal  of  Obstetrics,  May,  18G9. 


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Percira's  Physician's  Prescription  Book. 

Containing  Lish  of  Terms,  Phrasci^,  Contractions,  and  Abbreviations,  tised 
in  Prescriptions,  with  ^Explanatory  Notes,  the  Grammatical  Constructions 
of  Prescriptions,  Pules  for  the  Pronunciaiion  of  ] Pharmaceutical  Terms, 
A  Prosodiacal  Vocabulary  of  the  Names  of  Drugs,  etc.,  and  a  series  of 
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to  which  is  added  a  Key,  containing  the  Prescriptions  in  an  unabbreviated 
Form,  with  a  Literal  Transkdion,  intended  for  the  use  of  Medical  and 
Pharmaceutical  Students.  By  Jonathan  Pereira,  M.D.,  F.R.S.,  etc. 
From  the  Fourteenth  London  Edition. 

Price,  in  cloth, $1.25 

"      in  leather,  with  Tucks  and  Pocket,      .        .        .  1.50 

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Physicians  Visiting  List.       Published  annually. 

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Prince's  Orthopedic  Surgery. 

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Octavo $3.00 

"Thia  1b  a  good  book,  upon  an  important  practical  subject;  carefully  written,  abundantly  illustrated,  and 
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cl'  rx)mpilation  can  be  so.    Such  a  book  was  wanted,  and  it  deserves  success."  —  Mtd.  dc  Surg.  Reporter. 

Prince's  Plastic  Surgery. 

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Radcliffe's  Lectures  on  Epilepsy,  Pain,  Pa- 
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A7id  certain  other  Disorders  of  the  Nervous  System,  by  Chaeles  Bland 
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"The  reputation  which  Dr.  Radcliffe  possesses  as  a  very  able  authority  on  nervous  affeotious,  •n'lU  commend 
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much  concerning  them  being  involved  in  uiysterj';  and  while  Dr.  Radcliffe  has  taken  advantage  of  the  ample 
room  to  theorize,  which  his  subject  afforded,  he  has  not  failed  to  bring  forward  strong  and  formidable  facts  to 
prove  (he  deductions  he  attempts  to  draw.  We  recommend  it  to  the  notice  of  our  readers  as  a  work  that  will 
throw  much  light  upon  the  Physiology  and  Pathology  of  the  Nervous  Pystem."  —  Canada  MedicalJournaJ, 

Robertson's  Manual  on  Extracting  Teeth. 

Founded  on  the  Anatomy  of  the  Parts  involved  in  the  Operation ;  the  Kinds 
and  Proper  Construction  of  the  Instruments  to  he  used;  the  Accidents 
liable  to  occur  from  the  Operation,  and  the  Proper  Remedies  to  retrieve 
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especjalLv  so  to  the  military  surgeon,  who,  in  times  like  the  present,  is  called  upon  bo  frequently  to  perform 
the  operation  of  extracting  teeth."  —  Denial  Cosmos. 

Ranking's  Half-yearly  Abstract  of  the  Medi- 
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Renouard's  History  of  Medicine, 

History  of  Medicine  from  its  origin  to  the  Nineteenth  Gevtury.  With,  an 
Appendix  containing  a  rhilusophical  and  Historical  Review  of  Medi- 
cine to  the  present  time.  By  P.  V.  Renouard,  M.  D.  Trayislated 
from  the  French  by  Cornelius  G.  Comeoys,  M.  D.,  Professor  of  the 
Institutes  of  Medicine  in  the  Medical  College  of  Ohio,  etc.  In  One 
Volume  Octavo.     Price, $4.00 

"From  the  pages  of  Dr.  Renouard,  a  very  accurate  acquaintance  may  be  otitained  with  the  history  of  medi- 
cine—its  relation  to  civilization,  its  progress  compared  with  other  sciences  and  arts,  its  most  distinguished 
cnltivators  \Tlth  the  several  theories  and  systems  proiiosed  by  them,  and  its  relationship  to  the  reigning  phil- 
osophical dogmas  of  the  several  periods.  His  historical  narration  is  clear  an<l  concise,  tracing  the  progress 
of  medicine  through  its  three  ages  or  epochs  — that  of  foundation  or  origin,  that  of  tradition,  and  that  of 
renovation."- American  Journal  of  Medical  Science. 

"The  beat  history  of  medicine  extant,  and  one  that  will  find  a  place  in  the  library  of  every  physician  who 
Aims  at  nn  acquaintance  with  the  past  history  of  his  profession.  There  arc  many  items  in  it  we  should  like 
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Ryan's  Pliilosophy  of  Marriage. 

In  its  Social,  Moral,  and  Phtjdcal  Relations,  with  an  Account  of  the  Dit- 
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Reese's  Analysis  of  Physiology. 

Being  a  Condensed  Vienj  of  the  most  important  Facts  and  Doctrines,  r/e- 
signed  especially  for  the  Jj>ie  of  Students.  By  John  J.  Reese,  I\I.D., 
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Stille's  Epidemic  Meningitis ; 

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d'c.  dx.     In  One  Volume  Octavo. $2.00 

"This  monograph  is  a  timely  publication,  comprehensive  in  its  scope,  and  presenting  within 
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Sanson!  on  Chloroform. 

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although  in  his  preface  he  objects  to  the  'hackneyed  expression  of  endeavoring  to  supply  a  want,'  this  is  juflt 
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Scanzoni's  Practical  Treatise  on  the  Diseases 
of  the  Sexual  Organs  of  Women. 

Translated  from  the  French  of  Drs.  H.  Dor  and  A,  Socin,  and  annotated 
with  the  ajjproval  of  the  authors.  By  A.  K.  Gardner,  A.M.,  M.D., 
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Stokes  on  the  Diseases  of  the  Heart  and  the 
Aorta. 

By  William  Stokes,  Regius  Professor  of  Phy^inic  in  the  University  of 
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Spratt's  Obstetrical  Tables. 

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Skoda  on  Auscultation  and  Percussion. 

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Tanner's  Practice  of  Medicine. 

FIFTH  AMERICAN  EDITION. 
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Dr.  Tanner's  work  on  the  Practice  of  Medicine  is  so  well  known  in  this  country,  and 
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thing in  reference  to  it;  the  present  edition,  however,  contains  such  substantial  addi- 
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paratively small  volume  it  now  forms  a  handsome  octavo  of  nearly  1000  pages ;  all 
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matter  added,  written  in  the  same  condensed  and  easy  style. 

"The  leading  feature  of  this  book  U  its  essentially  practical  character.  Dr.  Tanner  has  produced  a  more 
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hard  practice,  and  it  is  therefore  valuable  as  a  guide,  and  trustworthy  as  an  exemplar."  —  i^orviun  Lancet. 

Tanner's  Practical  Treatise  on  the  Diseases 
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Octavo $3.00 

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complaints  of  those  subjects,  it  includes  many  afl'cctions  which,  though  common  to 
adults  and  children,  yet  ofl'er  some  modification  in  form,  or  in  the  indications  for  treat- 
ment, when  occurring  in  the  latter.  Thus,  we  have  an  account  of  diseases  of  the  eye, 
ear,  and  skin,  of  small-pox,  scrofula,  tuberculosis,  syphilis,  bronchocele,  and  cretinism, 
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hood. The  style  of  the  work  is  condensed,  and  the  book  might  with  truth  be  called 
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thing really  important  is  given,  while  the  discussion  of  disputed  subjects,  p.nd,  in 
fact,  of  everything  which  is  not  of  practical  importance  in  the  study  and  treatment  of 
children's  diseases,  is  omitted. 

Tanner's  Index  of  Diseases  and  their  Treat- 
ment. 

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every  disease,  including  many  surgical  diseases,  with  their  symptoms  and  mode  of  treatment;  an  admirable 
collection  of  Formulae,  and  an  account  of  the  climates  of  the  various  parts  of  the  world  suitable  for  invalids.  It 
also  contains  at  the  beginning  of  the  worlc  a  tabular  synopsis  of  subjects,  which  does  double  duty  at  once,  a 
Nosology  and  an  index.   It  will  be  found  a  most  valuable  companion  to  the  judicious  practitioner."  — iancrf. 

Tanner's  Memoranda  of  Poisons. 

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Trousseau's  Lectures  on  Clinical  Medicine. 

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cal  Medicine  in  the  Faculty  of  Medicine,  Paris.  Translated  and  edited, 
with  Notes  and  Appendices,  by  P.  Victoke  Bazire,  M.D.,  Assistoai 
Physician  to  the  National  Hospital  for  the  Paralyzed  aiid  Epileptic,  &c. 

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bo  popularized.  We  scarcely  know  of  any  vurk  better  fitted  for  present^ition  to  a  young  man  when  entering 
upon  the  practical  work  of  his  life.  The  delineation  of  the  recorded  ca.ses  is  graphic,  and  their  narration  de- 
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Tyler  Smith's  Obstetrics. 


A  Course  of  Lectures.  By  William  Tyler  Smith,  M,D.,  Physician,  Ac- 
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Toynbee  on  Diseases  of  the  Ear.    Their  Nature, 

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Thompson's  Clioical  Lectures  on  Pulmonary 
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Tyson's  Cell  Doctrine: 

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vania, &c.,  &c  In  Que  Volume,  with  a  Colored  Plate,  and  numerous 
Illustrations  on  Wood.     Price,  $2.00 

Tilt's  Elements  of  Health,  and  Principles  of 
Female  Hygiene. 

By  F.  J.  Tilt,  JM.D.,  Senior  Physician  to  the  Lying-in  Charity,  Author 
of  Works  on  the  Diseases  of  Menstruation,  Uterine  Therapeutics,  d'c, 
ct-c.     12mo SI  50 

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devoted  to  the  ago  from  fourteen  to  twtnty-oiKi  yc'ars  contain*  mucli  Tuliiable  advice  respecting  the  menstrual 
ftmction  during  that  period.  Tables  showing  the  value  of  life  at  each  of  the  different  jieriods  of  life,  ar« 
•ppended  in  thi'ir  proper  places;  and  the  work  also  contains  other  statistics  of  value  and  interest.  Th« 
whole  work  hius  been  prepared  with  groat  care,  and  contains  a  largo  amount  of  valuable  infonaation,  whjcb 
profo«8ional  men  may  coiuult  with  profit." — jV.  F.  it'dicol  Timet. 


LINDSAY   AND   BLAKISTON'S    PLBLICATIONd. 


Taylor's  Theory  and  Practice  of  the  Move- 
ment-Cure. 

Or,  the  Treatment  of  Lateral  Curvature  of  the  Spine,  Paralysis,  Indigedioit^ 
Constipation,  Consumption,  Angular  Curvatures,  and  other  Deformities, 
Diseases  Incident  to  Women,  Derangements  of  the  Nervous  System,  and 
other  Chronic  Affections,  by  the  Swedish  Sydem  of  Localized  Movements. 
By  CiiAKLES  Taylor,  M.D.      With  Illustrations.     12mo.      .         $1.50 

The  work  of  Dr.  Taylor  is  a  systematic  treatise,  containing  the  principles  on  which 
this  treatment  is  bascf),  and  full  and  explicit  directions  in  their  application  to  indi- 
vidual diseases.  The  author  discusses  the  nutritive  processes,  muscular  contraction, 
and  the  physiology  of  general  exercise,  the  subjects  of  the  first  three  chapters,  in  a 
most  satisfactory  manner.  The  work  is  purely  of  a  scientific  character,  and  commenda 
itself  as  such  to  the  attention  of  all  physicians. 

Virchow's  Cellular  Pathology. 

As  based  upon  Physiological  and  Pathological  History.  Translated  from 
the  Second  Edition  of  the  Original.  By  Frank  CnANCE,  B.A.,  M.A., 
Cantab  Licentiate  of  the  Royal  College  of  Physicians,  &c.,  &e.  With 
Notes  and  Numerous  Emendations,  principally  from  AfSS.  Notes  of  the 
Author,  and  Illustrated  by  144  Engravings.     Octavo.   .         .         $5.00 

Pi'of.  Virchow  and  his  writings  are  well  known  wherever  the  science  of  medicine  is 
studied.  This  work  has  been  selected  by  the  Medical  Bureau  of  the  United  States  for 
general  distribution  in  the  hospitals  and  medical  stations  of  the  army;  recording,  as 
it  does,  the  researches  in  this  branch  of  science  down  to  the  present  time. 

The  importance  of  the  subject,  the  new  ideas  advanced,  and  the  established  repu- 
tation of  the  author,  induced  the  publication  of  this  book,  and  has  made  it  a  standard 
work  throughout  Europe  and  in  this  country. 

Virchow  on  Morbid  Tumors. 

IN    PREPARATION. 

Walker  on  Intermarriage. 

Or,  the  Mode  in  which,  and,  the  Causes  why.  Beauty,  Health,  and  Intellect 
result  from  certain  Unions,  and  Deformity,  Disease,  and  Insartity  from 
others.  With  Illustrations.  By  Alexander  Walker,  Author  of 
"Woman,"  "Beauty,"  &c.,&c.     12mo S1.50 

"The  author  is  evidently  a  cnrefnl  obserrer,  and  a  proper  thinker,  and  h:i9  presented  us  with  a  vast  amonnt 
•jf  inlornjation,  derived  both  from  man  and  the  inferior  animals.  lie  has  aimed  to  be  useful,  by  pointing  out 
how  bodily  deformities  and  mental  infirmities  may  be  forestalled;  and  hovr  marriagt>9  among  blood  relations 
tend  to  the  degeneracy  of  the  offspring.  lie  also  shows  how,  by  carefully  assorted  marriages,  the  means  of 
Improving  general  organization  and  beauty  of  countenance,  as  well  a-s  mental  and  pli.vKieal  vigor,  are,  in  a 
great  degree,  under  the  coutrol  of  man.  Although  not  strictly  a  medical  work,  we  cannot  refrain  from  conj- 
mending  it  to  the  pe»iisal  of  the  Profession,  as  it  containj  moch  that  is  valnable  in  a  hygienic  point  of  riew."  — 
Medical  Exaviiner 


LINDSAY   AND    BLAKISTON'S    PUBLICATIONS. 


Wytlies'  Physician's  Pocket,  Dose,  and  Symp- 
tom Book. 

Containing  the  Doses  and  Uses  of  all  the  Prhicipal  Articles  of  the  Materia 
Medica,  and  Original  Preparations ;  A  Table  of  Weights  and  Meor 
sures,  Rules  to  Proportion  the  Doses  of  Medicines,  Common  Abbre- 
viations u^ed  in  Writing  Prescriptions,  Table  of  Poisons  and  Antidotes, 
Classification  of  the  Materia  Medica,  Dietetic  Preparations,  Table  of 
Symptomatology,  Outlines  of  General  Pathology  and  Therapeutics,  <t*e. 
By  Joseph  H.  Wythes,  A.M.,  M.D.,  &c.    2Vie  Eighlh  F.evised  Edilion. 

Price,  in  cloth, $1.00 

"      leather,  tucks,  with  pockets,         ....  1.25 

This  little  manual  has  been  received  with  much  favor,  and  a  large  number  of  copies 
Bold.  It  was  compiled  for  the  assistance  of  students,  and  to  furnish  a  vade  mecum  for 
the  general  practitioner,  which  would  save  the  trouble  of  reference  to  larger  and  more 
elaborate  works.  The  present  edition  has  undergone  a  careful  revision.  The  thera- 
peutical arrangement  of  the  Materia  Medica  has  been  added  to  it,  together  with  Bucii 
other  improvements  as  it  was  thought  might  prove  of  value  to  the  woi  4. 


Waring's  Manual  of  Practical  Therapeutics. 

Considered  chiefly  with  reference  to  Articles  of  the  Materia  Medica.  By 
Edward  John  Waring,  F.R.C.S.,  F.L.S.,  &c.,  &c.  From  the  Second 
London  Edilion.     Royal  Octavo. 

Price,  in  cloth, $6.00 

"      in  leather, 7.00 

There  are  many  features  in  Dr.  Waring's  Therapeutics- which  render  it  especially 
valuable  to  the  Practitioner  and  Student  of  Medicine,  much  important  and  reliable  in- 
formation being  found  in  it  not  contained  in  similar  works ;  it  also  differs  from  them 
in  its  completeness,  the  convenience  of  its  arrangement,  and  the  greater  prominence 
given  to  the  medicinal  application  of  the  various  articles  of  the  Materia  Medica  in  the 
treatment  of  morbid  conditions  of  the  Human  Body,  &c.,  &c.  It  is  divided  into  two 
parts,  the  alphabetical  arrangement  being  adopted  throughout  the  volume.  For  the 
further  convenience  of  the  reade-  there  is  also  added  an  Index  of  Diseases,  with  a 
list  of  the  medicines  applicable  as  remedies,  and  a  full  Index  of  the  medicines  and 
preparations  noticed  in  the  work. 

"  Our  (xtmiration,  not  only  for  the  immense  industry  of  the  anthor.  but  also  of  the  great  practical  value  of 
the  volume,  increases  with  every  reading  or  consultation  of  it.  We  wish  a  copy  couU  be  put  in  the  hands 
of  every  student  or  pr.'ictitiouer  in  the  country.  In  our  estimation  it  is  the  best  book  of  the  kind  ever 
written."  —  N.  T.  Medical  Journal. 

Weber's  Clinical  Hancl-Book  of  Auscultation 
and  Percussion. 

An  Exposition  from  First  Principles  of  the  Method  of  Investigating 
Diseases  of  the  Respiratory  and  Circulating  Organs.  Translated  by 
John  Cockle,  M.  L).      With  Illustrations.     Price,       .         .  $1.00 


LINDSAY   AND    BLAKISTON'S    PUBLICATIONS. 


Walton's  Operative  Ophthalmic  Surgery. 

By  Haynes  Walton,  F.R.C.S.,  Surgeon  to  the  Central  London  OphthaU 
mic  Iloxpital,  &c.  With  169  Illustrations.  Edited  by  S.  Littell, 
M.D.,  Surgeon  to  the  Wills  Hospital  for  the  Diseases  of  the  Eye,  &c. 
Octavo $4.00 

"  It  is  eminently  a  practical  work,  evincing  in  its  author  great  research,  a  thoroagb  knowledge  of  bid  sub- 
ject, and  an  accurate  and  most  observing  mind."  —  Dublin  QuarUrly  Journal. 

Watson's  Practice  abridged. 

A  Synopsis  of  the  Lectures  on  the  Principles  and  Practice  of  Physic.  De- 
livered at  King's  College,  London,  by  Thomas  Watson,  M.D.,  Fellow 
of  the  Royal  College  of  Physicians,  &c.,  &c.  From  the  last  London 
Edition.  With  a  concise  but  Complete  Account  of  the  Properties,  Uses, 
Preparations,  Doses,  &c.,  of  all  the  Medicines  mentioned  in  these  Lectures, 
and  other  Valuable  Additions,  by  J.  J.  Meylor,  A.M.,  M.D.,  &c.,  &c. 
A  neat  Pocket  Volume  bound  in  cloth  flexible.         .         .        .         $2.00 

Wells'  Treatise  on  the  Diseases  of  the  Eye, 

illusf rated   by  Ophthalmoscopic  Plates  and  Numerous  E ngravingn  on 
Wood.     By  J.  ScELBERu  Wells,  Ophthalmic  Surgeon  to  King'^a  College 
Hospital,  &c.     Second  London  Edition,  cloth,  $6.50;  leather,  $7  50. 
This  is  the  author's  own  edition,  printed  in  London  under  his  supervision,  and  issued 
in  this  country  by  special  arrangement  with  him. 

Wright  on  Headaches. 

Their  Causes  and  their  Cure.  By  Henry  G.  Wright,  M.D.,  Membei 
of  the  Royal  College  of  Physicians,  &e.  &g.  From  the  Fourth  Loudon 
Edition.     12mo.     Cloth.       .         .         .    '     .         .         .         .        gL25 

♦'  Few  aflFections  are  more  unmanageable  and  more  troublesome  than  those  of  which 
this  essay  treats;  and  we  doubt  not  that  any  suggestions  by  which  we  can  relieve 
them  will  be  gladly  received  by  physicians.  The  author's  plan  is  simple  and  practical. 
He  treats  of  headaches  in  childhood  and  youth,  in  adult  life  and  old  age,  giving  in 
each  their  varieties  and  symptoms,  and  their  causes  and  treatment.  It  is  a  most  satis- 
factory monograph,  as  the  mere  fact  that  this  is  a  reprint  of  the  fourth  edition,  testifies. 

"The  great  pains  which  the  author  takes  to  clear  up  the  dift'erential  diagnosis  of  the 
different  varieties,  and  establish  a  satisfactory  basis  for  rational  treatment,  are  every- 
where visible.  While  such  a  valuable  fund  of  information  is  offered  to  the  practitioner 
Rt  the  cost  of  a  single  visit,  he  should. not  let  his  patient  suffer  for  want  of  it,"  — 
Medical  and  Surgical  Reporter. 


and 


Wells  on  Long,  Short,  and  Weak  Sight 

their  Treatment  by  the  Scientific  Use  of  Spectacles.  Third  Edition  Re- 
vised, with  Additions  and  Numerous  Illustrations.  By  J.  S(ELBerg 
Wells.     Octavo.         .....  Price,  $3.00 


LINDSAY   AND    BLAKISTON'S    PUBLICATIONS. 


Harris's  Dictionary  of  Medical  Terminology, 

Dental  Surgery,  and  the  Collateral  Sciences.  By  Chapin  A. 
Harris,  M.D.,  D.D.S.,  Professor  of  the  Principles  of  Dental  Surgery  in 
the  Baltimore  College,  Member  of  the  American  Medical  Association,  &c., 
&c.  The  Third  Edition,  car  (fully  revised  and  enlarged,  by  Ferdi- 
nand J.  S.  GoRGAS,  M.D.,  D.D.S.,  Professor  of  Dental  Surgery  in  the 
Baltimore  College,  &c.,  &c.     Royal  octavo.  Cloth,  ^6.50.  Leather,  $7.53 

This  Dictionary  has  been  for  a  long  time  out  of  print;  a  new  edition  has  been  much 
needed  by  the  Profession,  a  constant  and  increasing  demand  existing  for  it.  The  pres- 
ent edition  has  been  thoroughly  revised  by  Professor  Gorgas,  Dr.  Harris's  successor  in 
the  Baltimore  Dental  College.  Many  additions  and  corrections  have  been  made,  and 
some  iwo  to  three  thousand  new  words  added.  The  doses  of  the  more  prominent  medici- 
nal agents  have  also  been  added,  and  in  every  way  the  book  has  been  greatly  im- 
proved, and  its  value  enhanced. 

Harris's  Principles  and  Practice  of  Dental 
Surgery. 

The  Ninth  Edition,  with  320  Illustrations.     Royal  octavo. 
Price,  bound  in  cloth,  bevelled  boards,          ....         $6.00 
"  leather, 7.00 

This  edition  of  Dr.  Harris's  work  has  been  subjected  to  a  very  thorough  revision 
by  competent  professional  gentlemen,  and  contains  many  and  important  additions, 
bringing  the  work  fully  up  to  the  present  state  of  dental  science,  and  adding  greatly 
to  its  value.  The  illustrations  have  also  been  much  improved;  some  have  been  replaced 
by  new  drawings,  and  many  new  ones  have  been  added.  The  publishers  therefore 
offer  it  with  the  confident  assurance  that  it  will  now  be  found  a  thorough  elementary 
treatise,  a  teit-book  for  the  student,  and  a  useful  companion  and  guide  for  the 
practitioner. 

Bond's  Practical  Treatise  on  Dental  Medicine. 

Being  a  Compendium  of  Medical  Science,  as  Connected  with  the  Study  of 
Dental  Surgery.  By  TnoMAs  E.  Bond,  M.D.,  Professor  of  Special 
Pathology  and  Therapeutics  in  the  Baltimore  College  of  Dental  Surgery. 
The  Third  Edition.     Octavo So.OO 

"Wo  have  spoken,  or  Intended  to  apeak,  heartily  in  praise  of  Dr.  Bond's  work.  It  lias  nnniistakablo  evi- 
lence  of  thorough  medical  science  in  its  Hnbject-nmtter,  and  of  a  capital  authorship  in  Ita  style  and  tieat 
m<uit."  —  A  merican  Medical  Journal. 

Robertson's  Manual  on  Extracting  Teeth. 

Founded  on  the  Anatomy  of  the  Parts  involved  in  the  Operation,  the  Kinds 
and  Projyer  Construction  of  the  Instruments  to  be  Used,  the  Accidents 
likely  to  occur  from  the  Operation,  and  the  Proper  Remedies  to  be  Used. 
By  A.  Robertson,  M.D.,  D.D.S.,  &c.    A  iS'ew  Revised  Edition.  $1.50 

"This  work  is  valualilo  not  ooly  to  the  dental  student  and  practitioner, but  also  to  the  medical  stndent  and 
•urgM  u." —  Pental  Ousmos. 


LINDSAY    AND    BLAKISTON'S    PUBLICATIONS, 


Taft's  Practical  Treatise  on  Operative  Den- 
tistry. 

A    NEW    EDITION,   THOROUGHLY   REVISED. 

By  Jonathan  Taft,  D.D.S.,  Profe.'^sor  of  Operative  Dentkitrxjin  the  Ohio 
College  of  Dental  Surgery,  &c.  The  Second  Edition,  thoroughly  Revised, 
iviih  additions,  and  fully  brought  up  to  the  present  state  of  the  Science. 
Containing  over  100 1 llmtrations.     Octavo.       Leather,      .         .     $4.50 

"An  examination  of  Mr.  Tuft's  treatise  onablos  us  to  speak  most  favorably  of  it.  It  is  very  Diorongti  and 
vory  clear,  showing  tliat  tho  author  is  practically  familiar  with  the  art  which  he  teaches.  Tlie  engravinga 
are  aliunduiit  and  excellent,  and,  in  fact,  the  wholti  mechanical  execution  of  the  volume  is  admirable,  and 
reflects  much  credit  ou  the  publishers."  —  Boston  M'dical  and  Surgical  Journal. 

Fox  on  the  Human  Teeth. 

Their  Natural  History  and  Structure,  the  Treatment  of  the  Diseases  to 
which  they  are  Subject,  the  Mode  of  Inserting  Artificial  Teeth,  d:c.  JEdited 
by  Chapin  a.  Hahiiis,  M.D.,  D.D.S.,  &c.  With  250  Illustrations. 
Octavo $4.00 

Richardson's  Practical  Treatise  on  Mechani- 
cal Dentistry. 

Sf:C0ND    EDITION,  MUCH   ENLAEGED. 

By  Joseph  Richardson,  D.D.S.,  Professor  of  Mechanical  Dentistry  in 

the  Ohio  College  of  Dental  Surgery,  &g.      With  over  150  beautifully  exe- 
cuted 1  llustrations.     Octavo.      Leather $4.50 

Handy's  Text-Book  of  Anatomy, 

And  Guide  to  Dissections.  For  the  Use  of  Students  of  Medicine  and 
Dental  Surgery.  By  Washington  R.  Handy,  M.D.,  late  Professor  of 
Anatomy  and  Physiology  in  the  Baltimore  College  of  Dental  Surgery. 
With  312  Illustrations.     Octavo $4.00 

Coles  on  i/crorniities  of  the  Mouth. 

Congenital  and  Acquired,  wUh  their  Mechanical  Treatment.  By  James 
Oakley  Coles,  D.D.S.,  Member  of  the  Odonfological  Society,  &c.,  &c. 
Second  Edition,  Revised  and  Enlarged,  with  8  Colored  Engravings 
and  51  Illustrations  on  Wood.     Price,  .         .         .         .         $2  50 

Heath  on  the  Injuries  and  Disesaes  of  the  Jaws. 

The  Jacksonian  Prize  E^say  of  the  Poyal  College  of  Sui^geons  of  Eng- 
land, 18Gt.  By  CiiiiisToriiER  Heath,  F.  R.  C.S.,  Assistant  Surgeon 
to  University  College  Hosjntal  Over  150  Illustrations.  Octavo. 
Price, $6  00 

Tomes'  System  of  Dental  Surg-ery. 

By  John  Tomes,  F.R.S.,  Dentist  to  the  Dental  Hospital  of  London,  Author 
of  "  Tomes'  Dental  Physiology,"  d'c,  &c.  With  208  beautifully  executed 
Illustrations.     Octavo. §4.50 


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Cooley's  Toilet  and  Cosmetic  Arts. 

The  Toilet  and  Cornietic  Arts,  in  Ancient  and  Modern  Times.  With  <i 
Revieio  of  the  Different  Theories  of  Beauty  and  copioiis  allied  Informa- 
tion, Social,  Hygienic,  and  Medical,  including  Instructions  and  Cautions 
respecting  the  Selection  and  Use  of  Perfumes,  Cosmetics,  and  other  Toilet 
Articles;  and  a  Comprehensive  Collection  of  Fonnulce,  and  Directioju 
for  their  Preparation.  By  Arnold  J.  Cooley,  Axithor  of  "  Cyclopcedia 
of  Receipts :  Processes,  Data,  and  Collateral  Information,  &:c.,in  the  Arts 
and  Ma7ivfactures."  With  Index  to  about  6000  Matters  of  Interest,  Use 
or  Caution.     Demi-Octavo.    .......         $3.00 

Ott  on  the  Manufacture  of  Soaps  and  Candles. 

Including  the  Most  Recent  Discoveries,  embracing  all  kinds  of  Ordinary 

Hard,  Soft,  ayid  Toilet  Soaps,  especially  those  made  by  the  Cold  Process; 

and  the  Modes  of  Detecting  Frauds  in  the  Mamfacturing  and,  the  Making 

of  Talloiv  and   Composite   Candles.     By  Adolph  Ott,  Pra,ctical  and 

Analytical  Chemist.     12mo.      With  Illustrations.     (Just  ready.)     $2.50 

The  author,  in  preparing  this  volume,  has  been  careful  to  give  a  clear  and  concise 

p-ccount  of  the  art  of  soap  and  candle  naaking,  as  now  practised,  so  as  to  make  the  work 

as  practical  iu  its  character  as  possible.     Appropriate  illustrations  have  been  added, 

and  critical  explanations  of  the  various  manipulations  and  mechanical  arrangements, 

by  which  they  are  efiected.     Much  new  matter  has  also  been  incorporated  in  the  book, 

never  before  published. 

Piesse's  Whole  Art  of  Perfumery. 

A    NEW    REVISED    AND    ENLARGED    EDITION. 

And  the  Methods  of  Obtaining  the  Odors  of  Plants ;  with  Instructions  for 
the  Manufacture  of  Perfumes  for  the  Handkerchief,  Scented  Powders, 
Odorous  Vinegars,  Dentifrices,  Pomatums,  Cosmetics,  Perfumed  Soaps, 
&c. ;  to  which  is  added  an  Appendix,  on  Preparing  Artificial  Fmii 
Essences,  &c.  By  G.  W.  Septimus  Piesse,  Analytical  Chemist.  A  new 
American  from  the  Third  London  Edition.     12mo.     With  Numerous 

Illustrations. $3.00 

Dr.  Piesse's  volume  covers  the  entire  ground  of  the  subject  upon  which  it  treats. 
It  is  full  of  Useful  and  Curious  Information,  including  also  many  Valuable  Formulae ; 
an  I  will  be  found  of  equal  importance  and  interest  to  the  practical  man  as  to  the  gen- 
eral reader. 

Overman's   Practical   Mineralogy,  Assaying 
and  Mining. 

With  a  Description  of  the  Useful  Minerals,  and  Instructions  for  Assaying, 
according  to  the  simplest  Methods.  By  Frederick  Overman,  Mining 
Engineer,  &c.     12mo $1.2.T 

The  object  of  this  volume  is  to  place  before  the  public  the  characteristics  and  uscf 
«f  minerals,  in  a  popular  style,  avoiding,  as  far  as  possible,  the  use  of  scientific  and 
technical  terms.  The  subject  is  divided  into  three  parts:  —  Mineralogy,  or  a  Descrip- 
tion of  the  Appearance  of  Minerals,  with  the  localities  in  which  they  may  or  have  been 
found ;  Assaying,  or  an  Investigation  of  the  value  of  Minerals,  by  means  which  are 
within  the  reach  of  every  one ;   and  Practical  Mining  in  its  simplest  form. 

Piggott  on  Copper  Mining  and  Copper  Ore. 

Containing  a  full  Description  of  some  of  the  Principal  Copper  Mines  of  the. 
United  States,  the  Art  of  Mining,  the  Mode  of  Preparing  the  Ore  for 
Market,  d'c,  &r.  By  A.  Snowden  Piggott,  M.D.,  Practical  Chemist 
12mo. «1.5n 


LINDSAY   AND   BLAKISTON'S    PUBLICATIONS 


Morfit's  Chemical  and  Pharmaceutical  Man- 
ipulations. 

A  Manual  of  the  Chemical  and  Chemico- Mechanical  Operations  of  the 
Laboratory.  By  Campbell  Morfit,  Professor  of  Analytic  and  Applied 
Chemistry  in  the  University  of  Maryland,  assisted  by  Clarence  Morfit, 
AssiMant  Melter  and  JRefiner  in  the  United  States  Assay  Office.  The 
Second  Edition,  Revised  and  Greatly  Enlarged,  with  over  5U0  Illustra- 
tlom.     Octavo S5.00 

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Plate  XVII.     Brain,  spinal  marrow,  and  envelopes.     Organs  of  the  senses.     Larynx, 

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Plate  XVIII.     Alimentary  canal ;  stomach,  intestines,  chyliferous  vessels,  peritoneum. 

Plate  XIX.  Stomach,  liver,  pancreas,  .'!])lcen,  kidney's,  supra-renal  capsules,  bladder.  Abdcminal 
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